Fillable LOCAL EARNED INCOME TAX RETURN TAXPAYER ANNUAL

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LOCAL EARNED INCOME TAX RETURN TAXPAYER ANNUAL

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TAXPAYER ANNUAL
LOCAL EARNED INCOME TAX RETURN
CLGS-32-1 (10-21)
You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and collection of local taxes. Contact your Tax Ocer.
DATES LIVING AT EACH ADDRESS
STREET ADDRESS (No PO Box, RD or RR) CITY OR POST OFFICE STATE ZIP
/ / TO / /
/ / TO / /
e-le at www.KeystoneCollects.com
Tax Year
If you moved during the tax year, le one return for each municipality (enter PSD Code for each jurisdiction). Use Part-Year Resident Schedule on back to calculate income and taxes for each return.
www.KeystoneCollects.com
DAYTIME PHONE NUMBER RESIDENT PSD CODE
EXTENSION REQUEST
FORM
see Instructions A5
Download form at www.KeystoneCollects.com
AMENDED RETURN
The calculations reported in the rst column MUST pertain to the name
printed in the column, regardless of which spouse appears rst.
Combining income is NOT permitted.
USE ONLY BLACK OR BLUE INK TO COMPLETE THIS FORM
Single
Married, Filing Jointly
Married, Filing Separately
disabled disabled
deceased deceased
homemaker homemaker
unemployed
unemployed
student student
military military
retired retired
If you had NO EARNED INCOME
check the reason why:
If you had NO EARNED INCOME
check the reason why:
1. Gross compensation as reported on W-2(s)
(enclose W-2s) ......................................
2. Unreimbursed Employee Business Expenses (enclose PA Schedule UE) .............
3. Other Taxable Income (see Instructions; enclose supporting documents) ....................
4. Total Taxable Income (subtract Line 2 from Line 1 and add Line 3)................................
5. Net Prots (enclose PA Schedules) ............................................................................................
NON-TAXABLE S-CORP
earnings check this box
(enclose S-Corp Schedule)
6. Net Loss (enclose PA Schedules) ...............................................................................................
7. Total Taxable Net Prot (subtract Line 6 from Line 5; if less than zero, enter zero) ...
8. Total Taxable Income and Net Prot (add Line 4 and Line 7) .......................................
9. Tax Liability (Line 8 multiplied by ) ..............................................
10. Income Tax Withheld (may not equal W-2; see Instructions) ............................................
11. Quarterly and Extension Payments/Credit From Previous Year ............................
12. Credits: Out-of-State Philadelphia and Act 172
13. PAYMENTS and CREDITS
(add Lines 10, 11, and 12) ....................................................
14.
Refund: enter if $2 or more; or select credit option in Line 15 ..........................
15.
Credit to Taxpayer/Spouse if $2 or more, apply credit as follows ..............................
Credit to next year Credit to spouse
16. TAX BALANCE DUE (Line 9 minus Line 13 ) .......................................................................
17. Penalty after April 15 (multiply Line 16 by ____ x number of months late) ...................
18. Interest after April 15 (multiply Line 16 by 0.0025 x number of months late) ................
19. TOTAL PAYMENT DUE (add Lines 16, 17 and 18) .........................................................
Spouse’s Social Security #
Social Security #
Do not photocopy or print more than one W-2 or Form 1099 on the same page.
Under penalties of perjury, I (we) declare that I (we) have examined this information,
including all accompanying schedules and statements and to the best of my (our) belief, they are true, correct and complete.
YOUR SIGNATURE SPOUSE’S SIGNATURE (if ling jointly)
DATE (MM/DD/YYYY)
PREPARER’S PRINTED NAME AND SIGNATURE PHONE NUMBER
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LAST NAME, FIRST NAME, MIDDLE INITIAL SPOUSE’S LAST NAME, FIRST NAME, MIDDLE INITIAL
STREET ADDRESS (No PO box, RD or RR)
SECOND LINE OF ADDRESS
CITY OR POST OFFICE
COUNTY
SCHOOL DISTRICT
MUNICIPALITYSTATE ZIP CODE
Include supporting documentation to verify income and credits below.
S-CORPORATION REPORT
Report passive or unearned S-Corporation income (losses)
that were reported on your PA-40 Return.
$
.0 0
$
.0 0
TAXPAYER TAXPAYER SPOUSE
PART-YEAR RESIDENT SCHEDULE
If you moved to another municipality, use this schedule to calculate income and taxes owed to each taxing jurisdiction. File one local earned
income tax return for each PA municipality. Report taxable income, tax paid and tax liability for each PA municipality separately on each return.
Current Residence (street address) # months at this address
(municipality, State, ZIP)
PSD Code - Current Residence
Employer (1)
Income $ divided by 12 months X (months at this address) = $
Withholding $ divided by 12 months X (months at this address) = $
Employer (2)
Income $ divided by 12 months X (months at this address) = $
Withholding $ divided by 12 months X (months at this address) = $
Current Residence Total Income $ Total Local Tax Withheld $
Put the Total Income on Line 1 and the Tax Withheld on Line 10 of the Local Earned Income Tax Return for your current residence taxing jurisdiction.
Previous Residence (street address) # months at this address
(municipality, State, ZIP)
Employer (1)
Income $ divided by 12 months X (months at this address) = $
Withholding $ divided by 12 months X (months at this address) = $
Employer (2)
Income $ divided by 12 months X (months at this address) = $
Withholding $ divided by 12 months X (months at this address) = $
Previous Residence Total Income $ Total Local Tax Withheld $
Put the Total Income on Line 1 and the Tax Withheld on Line 10 of the Local Earned Income Tax Return for your previous residence taxing jurisdiction.
PSD Code - Previous Residence
LINE 10: LOCAL EARNED INCOME TAX WITHHELD WORKSHEET
Complete worksheet if you work in an area where the non-resident tax rate exceeds your home resident rate
(1)
Local Wages
W-2 Box 16
(2)
Tax Withheld
W-2 Box 19
(3)
Resident EIT Rate
Tax Form Line 9
(4)
Workplace Location
“Non-Resident”
EIT Rate
(5)
Column (4) minus
Column (3)
If less than 0 enter 0
(6)
Disallowed
Withholding Credit
Col (1) times Col (5)
(7)
Credit Allowed for
Tax Withheld
Col (2) minus Col (6)
Example
1.
2.
3.
$10,000.00 $130.00 1.25% 1.30% 0.05% $5.00 $125.00
TOTAL Enter this amount on Line 10
LINE 12: OUT-OF-STATE TAX CREDIT WORKSHEET (see Instructions)
(Credit for income tax paid to non-reciprocal states must rst be applied to PA State tax. Credit for taxes paid may not exceed local resident EIT liability.)
Out-of-state income ......................................................................$
(Use gure from PA Schedule G-L)
Out-of-state tax paid .....................................................................$
(Use gure from PA Schedule G-L, Line 4.c)
PA state income tax liability ..........................................................$
(Out-of-state income x 3.07%)
Credit available against PA state tax liability ................................$
(Choose the lesser of the out-of-state tax paid and the PA state income tax liability)
Balance from PA state tax credit .............................................................. $
(subtract PA state tax liability from out-of-state tax paid)
Out-of-state income ......................................................................$
(Use gure from PA Schedule G-L)
Local Rate Multiplier (see Line 9 for local tax rate) ................................................. $
(Out-of-state income times local resident tax rate)
LOCAL EARNED INCOME TAX CREDIT FOR LINE 12 ........................................................................................ $
(Enter the lesser of the Balance from PA state tax credit and the Local Rate Multiplier on Line 12 of tax return)
A NOTE FOR RETIRED AND/OR SENIOR CITIZENS
If you are retired and are no longer receiving a salary, wages or income from a business, you may not owe an earned income tax. Social Security payments,
payments from qualied pension plans, interest and/or dividends accrued from bank accounts and/or investments are not subject to local earned income tax. If you
received an Annual Local Earned Income Tax Return, please check the “retired” box on the front of the form and return it to your tax collector. If you still receive wages
from a part-time employer or income from a business, you will need to le a return and pay the local earned income tax.
(required)
(required)
Use full # months; not fraction of month
Use full # months; not fraction of month
Use full # months; not fraction of month
Use full # months; not fraction of month
Use full # months; not fraction of month
Use full # months; not fraction of month
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LOCAL EARNED INCOME TAX RETURN TAXPAYER ANNUAL

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Completed 21 January 2022

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