Earned Income Tax Return Form
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1EARNED INCOME TAX RETURN
Year:
Richland Township Earned Income Tax Office
1328 California Road, Suite C
File this return on or before April 15th.
Quakertown, PA 18951
Make checks payable to:
215-536-4256
Fax: 215-536-1674
Richland Township EIT
Website:
Township:
Phone Number:
If you moved into or out of a Pennsylvania taxing district, you must file a pro-rated return with each district for the time spent in each, and
include a copy with this return.
IF FILING “0”, CHECK BOX:
Present address: _______________________________________________ From ___/___/___
HOUSEWIFE
OTHER (Explain)
To ___/___/___
_______________
_______________________________________________
RETIRED
DISABLED
Former address: _______________________________________________ From ___/___/___
Social Security #
To ___/___/___
_______________________________________________
1
1. Gross Earned Income (Attach W-2 & 1099) (See back of form)
2
2. Unreimbursed Business Expenses (Attach copy of PA UE Form for each employer)
3
3. Net Profit from Business (Attach copies of all applicable Federal Schedules)
4
4. Net Loss from Business (Attach copies of all applicable Federal Schedules)
Deduct from Net Profit ONLY (See back of form)
5
5. Subtract Line 4 from Line 3 (If less than zero, enter zero)
6
6. Income Subject to Tax (Line 1 less Line 2 plus Line 5)
7
7. Local Tax (.016 x line 6)
8
8. Local Tax Withheld by Employer(s)
9
9. Estimated Tax Payments and Carryover Credit
10
10. Credit for Tax Paid to Other States (Must Attach PA and Other State Return)
and Philadelphia (on Phila. earnings only - Phila. tax NOT refundable)
11
11. Total (Lines 8, 9 & 10)
12
12. If Line 7 is larger than Line 11, enter balance due
13
13. Penalty & interest of 1% per month on balance due (If not paid by April 15th)
14
14. Penalty for NOT making quarterly estimates (8% of Line 12)
15
*
15. Delinquent Late Fee: $10.00 per taxpayer (If filed after April 15th)
16
16. TOTAL DUE (Make check payable to: Richland Township EIT)
Disregard Overpayments or Underpayments less than $1.00
17. Overpayment (Line 11 less Line 7) (If under $10, credit ONLY - see back)
$___________
Refund
17
$___________
Credit
*
NOTE: Extension must be filed by April 15th to avoid delinquent late fee.
I declare under the penalties provided by law that I have examined this return. To the best of my knowledge and belief, it is a true and complete return.
Taxpayer
Signature: _____________________________________________________________
Date: _____________________________
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