TAX YEAR ANNUAL RECONCILIATION Earned Income Tax Return for residents of the Gateway School District 1 PA Wages from W2 box 16 or part year from to

							TAX YEAR                                       ANNUAL RECONCILIATION

Earned Income Tax Return for residents of the Gateway School District
 1 PA Wages from W2 box 16 or part year from ________ to _______ ATTACH ALL W2                                                                       1
 2 Net Profits from PA40 return line 4                            ATTACH SCHEDULE C and/or PA RK-1                                                   2
 3 LESS Business Expenses from PA-UE only                                           ATTACH SCHEDULE                                                  3
 4 Total Taxable Earnings (Line number 1 + 2 - 3)                                                                                                    4
 5 Nontaxable S Corporation (do not include in line 6 calculation)                  ATTACH SCHEDULE                                                  5
 6 Tax Due       (Multiply Line 4 X tax rate)   (Monroeville Residents 0.0150 - Pitcairn Residents 0.010)                                            6
 7 Tax Paid (include credits)                  WRITE IN AMOUNT FROM YOUR RECORDS                                                                     7
 8 Tax Balance Due with this return (Line 6 - 7)                                                                                                     8
 9 Interest and Penalty         if quarterly payments were late                      (1% per month)                                                  9
10 Balance Due / Overpayment - Circle One:             CREDIT NEXT YR                     REFUND                                                     10

     TO AVOID INTEREST AND PENALTY, MAKE PAYMENTS QUARTERLY                                                                       DUE BY: APRIL 15TH

By signing below, I verify to the best of my knowledge that this is a true and complete statement of my earnings.

Name and Address                                                                   Social Security No.
                                                                                        Employer Name

                                                                              Signature:

Make Check Payable & Mail To:                            E. I. T. COLLECTOR, MUNICIPALITY OF MONROEVILLE
                                                         2700 MONROEVILLE BLVD MONROEVILLE PA 15146-2388

PLEASE FOLLOW THESE INSTRUCTIONS FOR COMPLETING YOUR RETURN
 A. Provide copies of all income and deduction documents. Some examples of forms to enclose are:
    W-2, 1099 Misc., Schedule C, RK-1, PA-UE, S Corp. Include forms even if the tax was withheld.
 B. Pursuant to PA ACT 32 of 2008 business losses CANNOT be used to offset earned income.
    A business loss from one business CAN be used to offset net profits from another business.
 C. The signature of the taxpayer and date signed are required on the return.
 D. This return cannot be accepted if the appropriate documentation is not enclosed with your final return.
 E. If you owe a balance due greater than $1.00, make your payment payable to “EIT Collector.”

Additional Information:
 1 If your name or address has changed:                                       /     /       Effective Date
     New Name
     New Address
   Are you the owner of the new residence?
   Are you a tenant of the new residence?                                                                  (Please check one)
   If a tenant, provide Name of owner
 2 Provide DATE if there has been a change in your tax reporting method:
       /   /       Change in Employer:     Old Name
     New Name and Address

       /     /         Tax now withheld by your employer                           ____/____/____Tax no longer withheld by your employer

Direct Inquiries to: Earned Income Tax Office, 2700 Monroeville Blvd, Monroeville, PA 15146-2388
                     Telephone (412) 856-1045 Facsimile (412) 856-1054 Electronic Mail: Montax@Monroeville.PA.US

TAXPAYERS BILL OF RIGHTS DISCLOSURE STATEMENT: You are entitled to receive a written explanation of your rights with regard to the
           audit, appeal, enforcement, refund and collection of local taxes by contacting the Monroeville Tax Office between 9a.m. & 4 p.m.

              2c5284cb-4c1c-430c-b96f-486b2534e8bb.xls                            FINAL                                                       5/23/2011