Earned Income Tax Registration Form printable pdf download

Earned Income Tax Information for

Residents of Upper Salford Township and Souderton Area School District

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 tax for Upper Salford Township and Souderton Area School District is one (1%) and is levied on gross wages an/or

net profits from a business or profession.

Berkheimer Associates is the appointed Earned Income Tax Officer for Upper Salford Township and Souderton Area School District.

As the appointed Earned Income Tax Collector, Berkheimer Associates is charged with the duty of administering the Township’s and

School District’s taxes. This includes collecting the tax, establishing rules and regulations, to fairly enforce such tax and creating

accurate tax records and accounts for each taxpayer.

Below is an Earned Income Tax Registration Form. A completed Registration Form will fulfill your requirements under the Earned

Income Tax rules and regulations adopted by Upper Salford Township and Souderton School District. 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 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. Although, if you work in a jurisdiction where it is not

withheld or you are self-employed, you will have to pay the tax directly to Berkheimer Associates. Your completed registration form

will be forwarded to Berkheimer Associates, who will create an accurate tax account reflecting your correct reporting status and send

you the necessary tax forms.

We appreciate your cooperation in completing the registration form. Kindly refer to the attached for general questions and answers

about the earned income tax. If you have any additional questions, you may contact Berkheimer Associates at 610-588-0965,

extension 2, or in personal at your local Berkheimer Office.

Mail form to Upper Salford Township, P.O. Box 100, Salfordville, PA 18958

Upper Salford Township and Souderton Area School District

Earned Income Tax Registration Form

Your Name____________________________________________ Your Social Security No._________________________________

Spouse’s Name ________________________________________ Spouse’s Social Security No. _____________________________

Address ____________________________________________________________________________________________________

The Township _________________________________________ Date you moved to above address _________________________

Did you move here from another Pennsylvania Location? Yes _______ No _______

If yes, list previous address and resident school district _____________________________________________________________

Your Employer ________________________________________ Spouse’s Employer _____________________________________

Working Jurisdiction (Twp/Boro/City) ______________________ Working Jurisdiction (Twp/Boro/City) ______________________

Is the Earned Income Tax withheld from your pay? ____________ Is the Earned Income Tax withheld from your pay? ___________

Are you self-employed? __________________________________ Are you self-employed? ________________________________

If you have no earned income, please record the reason why: retired / homemaker / temporarily unemployed / disabled / student /

minor (please state age) / other (please specify)

You __________________________________________________ Spouse ______________________________________________

Your Signature _________________________________________ Date ___________________________

Earned Income Tax Registration Form