Form I301 - Local Earned Income Tax Return - Berkheimer Tax Administrator
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5LOCAL WORKSHEET (Moved During the Year)
F300 BAE-113 9/07
PART YEAR RESIDENT
Residence #1 ____________________
Dates ________ to ________ Length of Time______________
Residence #2 ____________________
Dates ________ to ________ Length of Time______________
INCOME PRORATION ( _____________________________________________________________________ )
Residence # 1 COMPLETE ADDRESS
Employer # 1 ___________________
Local Income $ _______________ / ____________ X _______________________ = ________________
12
# of months at this residence
Withholding $ _______________ / ____________ X _______________________ = ________________
12
# of months at this residence
Employer # 2 ___________________
12
Local Income
$ _______________ / ____________ X _______________________ = ________________
# of months at this residence
Withholding
$ _______________ / ____________ X _______________________ = ________________
12
# of months at this residence
Residence #1
Total Income ____________________ Total Withholding ____________________
INCOME PRORATION ( _____________________________________________________________________ )
Residence # 2 COMPLETE ADDRESS
Employer # 1 ___________________
Local Income $ _______________ / ____________ X _______________________ = ________________
12
# of months at this residence
Withholding $ _______________ / ____________ X _______________________ = ________________
12
# of months at this residence
Employer # 2 ___________________
12
Local Income $ _______________ / ____________ X _______________________ = ________________
# of months at this residence
12
Withholding $ _______________ / ____________ X _______________________ = ________________
# of months at this residence
Residence #2
Total Income ____________________ Total Withholding ____________________
NON RECIPROCAL STATE WORKSHEET
(See Instructions line 12)
EARNED INCOME: Taxed in other state as shown on the state tax return.
Enclose a copy of state return or credit will be disallowed ..........................................................................................
(1) ____________________
Local tax 1% or as specified on the front of this form ..................................................................................................
X ____________________
(2) ____________________
Tax Liability Paid to other state(s) ......................................................................................
(3) __________________
PA Income Tax (line 1 x PA Income Tax rate for year being reported) ..............................
(4) __________________
CREDIT to be used against Local Tax
(Line 3 minus line 4) On line 12, enter this amount
or the amount on line 2 of worksheet, whichever is less. (If less than zero, enter zero) ............................
(5) __________________
Please send completed return with all attachments to the appropriate address below:
Refund/Credit
Payment
No Refund / No Credit / No Payment
Berkheimer Tax Administrator
Berkheimer Tax Administrator
Berkheimer Tax Administrator
PO Box 903
PO Box 905
PO Box 907
Bangor, PA 18013
Bangor, PA 18013
Bangor, PA 18013
A NOTE TO RETIRED SENIOR CITIZENS ONLY
IF YOU ARE RETIRED AND NO LONGER RECEIVING A SALARY, WAGES OR INCOME FROM A BUSINESS
YOU RUN, YOU MAY NOT OWE ANY EARNED INCOME / NET PROFITS TAX.
SOCIAL SECURITY PAYMENTS AND PAYMENTS FROM A QUALIFIED PENSION PLAN ARE NOT SUBJECT TO
THE EARNED INCOME TAX. INTEREST ON BANK ACCOUNTS IS NOT SUBJECT TO THE EARNED INCOME
TAX EITHER.
IF YOU RECEIVE A FINAL EARNED INCOME TAX RETURN YOU SHOULD RETURN THE FORM SHOWING
THAT YOU HAD NO EARNINGS. CHECK THE APPROPRIATE BOX ON THE RETURN STATING THAT YOU
ARE RETIRED.
IF YOU ARE SEMI-RETIRED AND STILL RECEIVE WAGES FROM A PART-TIME JOB OR BUSINESS YOU
STILL RUN, YOU MUST STILL PAY THE EARNED INCOME / NET PROFITS TAX.
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