Fillable Local Earned Income Tax QUARTERLY ESTIMATED

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Local Earned Income Tax QUARTERLY ESTIMATED

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The Local Earned Income Tax QUARTERLY ESTIMATED form is 2 pages long and contains:

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If you have no earned income, state the reason: retired / homemaker /
student / disabled / temporarily unemployed /other
(please specify):
Check here if ALL tax is withheld by employer(s)
Do not complete information requested on Lines 1 through 6
Resident Municipality

1.

---------

(must enter amount) January 1 thru March 31- - - - - - - -
Employer withholding (January 1 thru March 31 only)
--

- - - - - - - - - - - - - - - - - -

per month (if paid after due date) -----------------
TOTAL PAYMENT DUE
(Line 4 plus Line 5) ---------
Payable to: KEYSTONE COLLECTIONS GROUP
SOCIAL SECURITY NUMBER

3.
4.
5.
6.

Check here if address change also applies to spouse


1st QUARTER Estimated Local Earned Income Tax
Due date: 04/15/2021
2021
Resident PSD Code Work Location PSD Code



Address
City

&
Zip

QUARTERLY ESTIMATED
Local Earned Income Tax

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.
Taxpayer Helpline: 1-866-539-1100
As a Pennsylvania resident, you are required to report your income and pay local earned income tax quarterly if you are:
 
 
 
 

Quarterly estimate payments are due within 15 days after the close of each calendar quarter. Late payment(s) may result

                   

from where

 
Voucher(s) for individual use only. Employers must le online or use the Employer Quarterly Return form.
save time online
13010121001041521000000000000000000008
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Resident Municipality

1.

---------

 -----

only)

- - - - - - - - - - - - - - - - - -

per month (if paid after due date) -----------------
TOTAL PAYMENT DUE
(Line 4 plus Line 5) ---------
Payable to: KEYSTONE COLLECTIONS GROUP

3.
4.
5.
6.

Check here if address change also applies to spouse


4th QUARTER Estimated Local Earned Income Tax
Due date: 01/15/2022
2021
Resident PSD Code Work Location PSD Code



Address
City

&
Zip
.00
.00
.00
.00
.00
.00
Resident Municipality

1.

---------

 -------

- -

- - - - - - - - - - - - - - - - - -

per month (if paid after due date) -----------------
TOTAL PAYMENT DUE
(Line 4 plus Line 5) ---------
Payable to: KEYSTONE COLLECTIONS GROUP

3.
4.
5.
6.

Check here if address change also applies to spouse


3rd QUARTER Estimated Local Earned Income Tax
Due date: 10/15/2021
2021
Resident PSD Code Work Location PSD Code



Address
City

&
Zip
.00
.00
.00
.00
.00
.00
If you have no earned income, state the reason: retired / homemaker /
student / disabled / temporarily unemployed /other
(please specify):
Check here if ALL tax is withheld by employer(s)
Do not complete information requested on Lines 1 through 6
Resident Municipality

1.

---------

(must enter amount) April 1 thru June 30 -----------
Employer withholding (April 1 thru June 30)
---------

- - - - - - - - - - - - - - - - - -

per month (if paid after due date) -----------------
TOTAL PAYMENT DUE
(Line 4 plus Line 5) ---------
Payable to: KEYSTONE COLLECTIONS GROUP

3.
4.
5.
6.

Check here if address change also applies to spouse


2nd QUARTER Estimated Local Earned Income Tax
Due date: 07/15/2021
2021
Resident PSD Code Work Location PSD Code


Address
City

&
Zip
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
If you have no earned income, state the reason: retired / homemaker /
student / disabled / temporarily unemployed /other
(please specify):
Check here if ALL tax is withheld by employer(s)
Do not complete information requested on Lines 1 through 6
If you have no earned income, state the reason: retired / homemaker /
student / disabled / temporarily unemployed /other
(please specify):
Check here if ALL tax is withheld by employer(s)
Do not complete information requested on Lines 1 through 6
13010121002071521000000000000000000004
13010121003101521000000000000000000008
13010121004011522000000000000000000007
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Local Earned Income Tax QUARTERLY ESTIMATED

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Completed 14 May 2021

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