Spouse’s Name: ___________________________________ Soc. Sec. #: _________________________________
New Address: ___________________________________________________________ as of: _________________
Please list previous address and previous school district:
Address: ____________________________ City________________________ State: ________ Zip: _________
School District: __________________________
Employer: _____________________________ Spouse’s Employer: ________________________
Earned Income Tax withheld from your pay: yes no From Spouse’s pay: yes no
Self-employed: yes no Spouse self-employed: yes no
No earned income: Please indicate reason (homemaker, temporarily unemployed, disabled, student etc; (please specify)
You: ___________________________________ Spouse: _____________________________________
Signature: _________________________________________________ Date: __________________
Earned Income Tax Information for
Residents of the Borough of Conshohocken, Montgomery County
In Pennsylvania, the General Assembly has empowered political subdivisions of the Commonwealth, at the local level, to levy, assess, and
collect certain types of taxes for general revenue purposes. The authority for levying these non-realty taxes was granted to local school
districts and municipalities in 1965 through the passage of the Local Tax Enabling Act (LTEA), commonly referred to as ‘Act 511’. The rate
of earned income tax for the Borough of Conshohocken is one percent (.5%) and is levied on gross wages and/or net profits from a business or
profession.
Berkheimer Tax Administrators is the appointed earned income tax administrator for Montgomery County. The appointed earned income tax
administrator, Berkheimer Tax Administrators is charged with the duty of collecting the Borough’s earned income taxes. This includes
collecting the tax, establishing rules to fairly enforce such tax and creating accurate tax records and accounts for each taxpayer.
Above is an Earned Income Tax Registration Form. A completed Registration Form will fulfill your registration requirements under the
Earned Income Tax Rules and Regulations adopted by the Borough of Conshohocken. More importantly, this information will ensure that
your tax dollars are sent to your home taxing jurisdiction. All residents should complete this form, regardless of your employment status
(unemployed, retired, college student, military personnel, or homemaker). If you have recently moved, please give your current and former
address.
Most resident taxpayers will have this tax deducted by their employers. Residents, who work in a jurisdiction where it is not withheld, or are
self-employed, will have to pay the tax directly to Berkheimer Tax Administrators. The completed registration form will be forwarded to
Berkheimer Tax Administrators, who will create an accurate tax account reflecting your current reporting status and send you the necessary
forms.
