| 1. TOTAL
GROSS EARNINGS FROM ALL W-2'S (NO ROUNDING) |
.............. |
1 ____________ |
2. LESS:
Allowable non-reimbursed employee business expenses
YOU MUST ATTACH COPY OF PA STATE FORM UE-1 OR UE-2 |
2 ______ |
|
| 3. TAXABLE
W-2 EARNINGS (Subtract line 2 from line 1) |
............... |
3 ____________ |
| 4. OTHER
TAXABLE EARNED INCOME (NO INTEREST OR DIVIDENDS) |
.............. |
4 ____________ |
| 5. TOTAL
TAXABLE EARNED INCOME (Add lines 3 and 4) NO
ROUNDING |
.............. |
5 ____________ |
6. NET LOSS
-Attach State Schedule
| |
_______________________
From Business
(Sch. C) |
________________________
From Farming
(Sch. F) |
___________________________
From
Partnership (Sch. K-1-1065)
|
|
6_______ |
|
| 7. SUBTOTAL
(Subtract line 6 from line 5) If less than zero, enter
zero |
............... |
7 ____________ |
8. NET PROFIT
- Attach State Schedule
| |
_______________________
From Business
(Sch. C) |
________________________
From Farming
(Sch. F) |
___________________________
From
Partnership (Sch. K-1-1065)
|
|
............... |
8 ____________ |
| 9. TOTAL
TAXABLE INCOME AND NET PROFITS (Add line 7 and 8) NO
ROUNDING |
............... |
9 ____________ |
| 10. TOTAL
INCOMETAX DUE Multiply line 9 by 1% (.01) |
10______ |
|
11. CREDIT
(a) Earned income tax
withheld by employer $_______________
(b) Quarterly payments
and last year's overpayment if credited
.............___________________ Total Credits
|
11 ______ |
|
| 12. If
your TAX DUE (line 10) is larger than your CREDIT (line
11) enter BALANCE OF TAX DUE NO ROUNDING |
................. |
12 ___________ |
| 13. PENALTY
AND INTEREST See Instructions |
................ |
13 ___________ |
| 14. $15.00
LATE FILING FEE |
................ |
14 ___________ |
| 15. TOTAL
PAYMENT DUE WITH THIS RETURN DISREGARD PAYMENT LESS THAN
$1.00 |
................ |
15 ___________ |
16.
IF YOUR CREDITS (LINE 11) ARE LARGER THAN YOUR TAX DUE
(LINE 10), ENTER OVERPAYMENT
REFUND OF $1.00 - $5.00 WILL BE CREDITED TO THE FOLLOWING
YEAR. NO REFUND UNDER $1.00.
| REFUND
> O
TO YOU |
O
CREDIT TO NEXT
YEAR'S ESTIMATED TAX |
O
CREDIT
TO SPOUSE - SS# |
|
16 ______ ______
|
|