Form 83-A272 - Wage Tax Refund Petition Commission Employees - 2014

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OFFICE USE ONLY
TAX YEAR
WAGE TAX REFUND PETITION
2014
COMMISSION EMPLOYEES
(Not to be used by Salaried Employees)
Read the instructions for both the Employer as well as the Employee on the reverse side of this form prior to completing this
petition. Print or type all information. The completed petition must include:
W-2 showing Federal, State, Medicare and Local wages
Signature of Employee and Employer
IRS Form 2106 if claiming expenses on Line 2E. If Form 2106 has an entry on Line 4, submit a breakdown of those expenses.
EMPLOYEE'S NAME
SOCIAL SECURITY NUMBER
DAYTIME TELEPHONE NUMBER
HOME ADDRESS
OCCUPATION
CITY
STATE
ZIP CODE
IF PARTIAL YEAR, PROVIDE DATES:
From
To
EMPLOYER
EMPLOYER IDENTIFICATION NUMBER (EIN)
PLACE OF EMPLOYMENT
COLUMN A
COLUMN B
January 1, 2014 to June 30, 2014
July 1, 2014 to December 31, 2014
.00
.00
1. Gross Compensation per W-2
A. Non-Taxable Stock Options included in Line 1 (Must reflect on W-2)
.00
.00
.00
.00
B. Adjusted Gross Compensation (Subtract Line 1A from Line 1)
2. Computation of taxable compensation and/or allowable expenses
.00
.00
A. Total Sales
B. Sales outside of Philadelphia. Supply breakdown of sales activity performed (i.e. solicited)
.00
.00
outside of Philadelphia including client’s name, address, and sales amounts attributable to each client.
C. Percentage of sales outside of Philadelphia
.
%
.
%
Divide Line 2B by Line 2A and round the resulting percentage to 4 decimal places.
.00
D. Commissions earned outside of Philadelphia. Multiply Line 1B by 2C.
.00
E. (i) Total non-reimbursed business expenses from Form 2106 and/or
.00
.00
Schedule A, Miscellaneous Deductions
.00
.00
(ii) Multiply amount on Line E (i) by the percentage on Line 2C
.00
.00
(iii) Deductible non-reimbursed employee business expenses. Subtract Line E (ii) from Line E (i)
.00
.00
F. Non-taxable commissions/deductible employee business expenses Add Line 2D and Line 2E (iii)
.00
.00
3. Net Taxable compensation (Line 1B minus Line 2F)
Resident of Philadelphia multiply Line 3, Column A by .03924 and Column B by .03920.
4. TAX
.00
.00
Non-Resident of Philadelphia Line 3, Column A by .03495, and Column B by .034915.
DUE
.00
5. TOTAL TAX DUE (Add Line 4, Column A and Line 4, Column B.)
.00
6. Wage tax withheld per W-2
.00
7. REFUND REQUESTED (Line 6 minus Line 5)
EMPLOYER CERTIFICATION
I certify that the facts shown above supporting employee's claims are correct based on available payroll records. Individuals serving as authorized official
signatories should be familiar with employee's time and attendance, as well as applicable Wage Tax Regulations. Income Tax Regulations Section 401
through 404 requires that the employer withhold and allocate wages for tax purposes. General Regulation Section 306 (2) provides that the employer, for
and on behalf of the employee, requests the refund.
AUTHORIZED OFFICIAL SIGNATURE (Signature must be clear and legible.)
PRINTED NAME
DAYTIME TELEPHONE NUMBER
EMPLOYEE CERTIFICATION
I HEREBY CERTIFY that the statements contained herein and in any supporting schedule or exhibit are true and correct to the best of my knowledge and
belief. I understand that if I knowingly make any false statements herein, I am subject to such penalties as may be prescribed by City Ordinance.
EMPLOYEE'S SIGNATURE (Signature must be clear and legible.)
DATE
83-A272 Rev. 12-4-2014

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