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Income Tax Forms in Pittsburgh Pa

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Income Tax Forms in Pittsburgh Pa document sample

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									                             SHALER AREA SCHOOL DISTRICT
                       PAYROLL DEDUCTION DATA – EARNED INCOME TAX


                PLEASE FURNISH THE FOLLOWING REQUIRED INFORMATION:

1.        Print name in which payroll checks, retirement, and other records are to be carried.
          (Note: This should be as it appears on your Social Security Card.)

          ________________________________________________________________________
          First                         Middle                  Last

2.        Social Security Number: _________-_____-_________

3.        Date of Birth: Month: ________ Day: ________ Year: _________

4.        Permanent address to be used for reporting earnings, retirement, etc.:

                                    ___________________________________________

                                    ___________________________________________

                                    ___________________________________________

5.        Telephone Number: (______)____________________________________

6.        Name of Municipality in which you live: _____________________________

          Wage tax will be deducted for the following municipalities:
          (Please  if applicable.)

      Aspinwall Boro (20)                     McCandless Twp. (16)                     Richland Twp. (23)
      Etna Boro (13)                          Millvale Boro (14)                       Ross Twp. (15)
      Fox Chapel Boro (22)                    O'Hara Twp. (19)                         Shaler Twp. (11)
      Hampton Twp. (17)                       Penn Hills (31)                          Sharpsburg (27)
      Indiana Twp. (21)                       Pittsburgh (10)                          West Deer Twp. (24)
                                              Reserve Twp. (12)

Employee                                                       Effective
Signature _________________________________ Date _____________________________
---------------------------------------------------------------------------------------------------------------------

                                                                                       Business Office ONLY
                                                                                 Initial               Please Date:
                                                                                 ____ Payroll ___________
(Revised 5/06                                                                    ____ Fringe ___________
(FORMS/Payroll Data)                                                             ____ Personnel __________
                                                                                 ____ PSERS     __________

								
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