INDIVIDUAL Tax Return. DO NOT combine spousal incomes.
____________________________________
e-file at www.keystonecollects.com
Check here if PART-YEAR RESIDENTComplete ITR-1 Schedule on reverse sideof this form and enclose copies of other municipal returns.
DO NOT STAPLE ANY ITEMS TO THIS RETURN
DUE DATE: 04/17/2012
546 Wendel RoadIrwin, PA 15642(724) 978-0300
___________________________________USE BLUE OR BLACK INK
* RETURN MUST BE FILED ON THIS FORM. No substitutions accepted.
RESIDENT OF MUNICIPALITY: _______________________________________
2011 Earned Income Tax ReturnKeystone Collections Group
Daytime Phone
Note all corrections/additions to SSN, name or addressand check box here.
1. Gross State Earnings as Reported on W2/1099 Enclose copies with this form ......
2. Unreimbursed Employee Business Expenses (Enclose PA Schedule UE) .........
3. Taxable W2/1099 Earnings (Line 1 minus Line 2) .................................................
4. Net Profit from Business, Profession or Farm (Submit PA Schedule C, F, RK1 or 20S) .................................................................................... Non Taxable SCorp Earnings (check box)5. Net Loss from Business, Profession or Farm (Submit PA Schedule C, F, RK1 or 20S) .................................................................................... Non Deductible SCorp Losses (check box)
6. Subtotal (Line 4 minus Line 5) IF LESS THAN ZERO, ENTER ZERO ....................
7. Total Earned Income and Net Profits (Line 3 plus Line 6) .....................................
8. Resident Tax (Line 7 multiplied by tax rate of ) ................................ (Tax Rate)
9. Credit for Earned Income Tax Withheld (Per W2. See Instructions for Line 9) .....
10. Estimated Payments or Credit (Direct payment made by you and/or credit from prior year) .....................................................................................
11. Miscellaneous Credits Philadelphia Credit (check box) (See Instructions and Worksheet) Out Of State Credit (check box) .........
12. Total (Line 9 plus Line 10 plus Line 11) ....................................................................
13. REFUND/CREDIT (Line 12 minus Line 8) IF $1.00 OR MORE, enter amount & check box below. INCLUDE PA40 INFO See Instructions ...................................
Apply to spouse Apply to next year Refund
14. TAX DUE (Line 8 minus Line 12) OMIT IF LESS THAN $1.00 .................................
15. Penalty (See Instructions for Line 15) .......................................................................
16. Interest (See Instructions for Line 16) .......................................................................
17. TOTAL AMOUNT DUE (Line 14 plus Line 15 plus Line 16) .....................................
Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying schedules and statements and to the best of my (our) belief, they are true, correct and complete.
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ENTER ACCOUNT TOTALS ON LINES 17 AND 18
546 Wendel RoadIrwin, PA 15642(724) 978-0300
$
DUE DATE: 04/17/2012
Mail this return to the above address.THIS VOUCHER MUST BE INCLUDED WITH YOUR RETURN.
2011 EARNED INCOME TAX
13210111005041612000000000000000000005
Employer _______________________________
Local Income $ _______________ / 12 months X _____________ (months at this residence) = ________________
Withholding $ _______________ / 12 months X _____________ (months at this residence) = ________________
Local Income $ _______________ / 12 months X _____________ (months at this residence) = ________________
Withholding $ _______________ / 12 months X _____________ (months at this residence) = ________________
Current Residence Total Income ____________________ Total Local Tax Withheld ____________________
Previous Residence _____________________________________________(street address) # months at this
_____________________________________________ (Municipality, State, ZIP) residence
Employer _______________________________
Employer _______________________________
Employer _______________________________
_________________________________________________________________________________________________________________________________
Current Residence ______________________________________________ (street address) # months at this
______________________________________________ (Municipality, State, ZIP) residence
__ __
Local Income $ _______________ / 12 months X _____________ (months at this residence) = ________________
Withholding $ _______________ / 12 months X _____________ (months at this residence) = ________________
Local Income $ _______________ / 12 months X _____________ (months at this residence) = ________________
Withholding $ _______________ / 12 months X _____________ (months at this residence) = ________________
Previous Residence Total Income ____________________ Total Local Tax Withheld ____________________
NonReciprocal State/Philadelphia Credit Schedule ITR-2 Schedule
Use this schedule if you moved into a new taxing jurisdiction during the tax year.
Philadelphia Other State
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
*If you paid both outofstate and Philadelphia wage tax, then enter on Line 11 of the local return the lower of (Line 4 plus Line 7) or (Line 2 (b) ). Remember, yourcredit cannot exceed your local tax liability.
Note: Do not use this nonreciprocal schedule ITR2 for state earned income tax paid to the reciprocating states of Maryland, New Jersey, Ohio, Virginia, West Virginia and Indiana. To recover tax paid to a reciprocating state, you must apply for a refund from the state where you paid the tax.
Ver. 12222011
PartYear Resident Schedule ITR-1 Schedule
_________________________________________________________________________________________________________________________________
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For income taxed in another state or taxed in the City of Philadelphia. Income: Earnings and Net Profits (as defined in Line 1 and Line 4 of the instructions) taxed in another state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1(a) XXXXXXXX ____________
Total Earned Income and Net Profits Reported on Line 7 of Local Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1(b) ____________ XXXXXXXX
Maximum Credit Allowed: Line 1(a) x local rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2(a) XXXXXXXX ____________
Line 1(b) x local rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2(b) ____________ XXXXXXXX
Actual Tax Paid: Actual tax paid to other state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3(a) XXXXXXXX ____________
Actual tax paid to Philadelphia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3(b) ____________ XXXXXXXX
Philadelphia Credit—Lesser of line 2(b) or Line 3(b)—enter on line 11 of local return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 ____________ XXXXXXXX
Additional limitation for out of state credit: Line 1(a) x PA Income Tax Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 XXXXXXXX ____________
Line 3(a) minus Line 5 (Remaining credit after application to Pennsylvania State Tax) . . . 6 XXXXXXXX ____________
Out of state credit—Lesser of line 2(a) or Line 6—enter on line 11 of local return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 XXXXXXXX ____________