Earned Income Tax Registration Form
Download a blank fillable Earned Income Tax Registration Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Earned Income Tax Registration Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2UPPER DUBLIN TOWNSHIP
801 Loch Alsh Avenue
Fort Washington, PA 19034-1697
Phone: (215) 643 - 1600
Fax: (215) 542 - 0797
EARNED INCOME TAX REGISTRATION FORM
TAXPAYER I
SOC SEC NUM
NAME
Last
First
MI
ADDRESS
Post Office
Number
Street
DATE OF RESIDENCE
Own
Rent
If renting, name of owner:
EMPLOYMENT STATUS:
Part-time
Employed: Full-time
Self-employed
Not Employed
TAX STATUS IF EMPLOYED:
No Local Tax Withheld
Phila. Wage Tax Withheld
Local Tax Withheld for:
(Locality)
EXEMPT FROM TAX FOR FOLLOWING REASON:
Active Military
Permanently retired as of
Temporarily Unemployed
Permanently disabled as of
Full-time Homemaker
Other
SIGNATURE
DATE
************************************************************************************************************************
TAXPAYER II
NAME
SOC SEC NUM
Last
First
MI
ADDRESS
Post Office
Number
Street
DATE OF RESIDENCE
Own
Rent
If renting, name of owner:
EMPLOYMENT STATUS:
Part-time
Employed: Full-time
Self-employed
Not Employed
TAX STATUS IF EMPLOYED:
No Local Tax Withheld
Phila. Wage Tax Withheld
Local Tax Withheld for:
(Locality)
EXEMPT FROM TAX FOR FOLLOWING REASON:
Active Military
Permanently retired as of
Temporarily Unemployed
Permanently disabled as of
Other
Full-time Homemaker
SIGNATURE
DATE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial