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FORM 531 - FINAL EARNED INCOME TAX RETURN                                                                                                             Attach all w-2's, 1099's and/or appropriate 
CUMBERLAND COUNTY TAX BUREAU                                                                                                                          copies of State Schedules
PHONE: 717-590-7997
WEB SITE: www.cumberlandtax.org
CLGS-32-1 (04-16)
                                                                        TAXPAYER ANNUAL
                                               LOCAL EARNED INCOME TAX RETURN 
     You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and collection of local taxes. Contact your Tax Officer.             
*If you have relocated during the tax year, please supply additional information.                                                                     Tax Year
DATES LIVING AT EACH ADDRESS                   STREET ADDRESS (No PO Box, RD or RR)                                             CITY OR POST OFFICE             STATE            ZIP
     /     /     TO  /     /
     /     /     TO  /     /
                                                                                                                                       **If you need additional space - please see back of form.

     Taxpayer A:
     Taxpayer B:

                                                                                                                                                                TAXPAYER A: ONLINE PIN

                                                                                                                                                                TAXPAYER B: ONLINE PIN

DAYTIME PHONE NUMBER                                                    RESIDENT PSD CODE
                                                                                                                     EXTENSION         AMENDED RETURN             NON-RESIDENT

                                                                                                                     Taxpayer A Social Security #     Taxpayer BSpouse’s()Social Security #
The calculations reported in the first column MUST pertain to the name printed
    above on the left and the calculations in the second column should be for the 
                        spouse name listed on the right.                                                             If you had NO EARNED INCOME,     If you had NO EARNED INCOME,
                     Combining income is NOT permitted.                                                              check the reason why:                   check the reason why:
    ONLY USE BLACK OR BLUE INK TO COMPLETE THIS FORM                                                                 disabled          student        disabled                 student
                                                                                                                     deceased          military       deceased                 military
     Single        Married, Filing Jointly        Married, Filing Separately        Final Return*                    homemaker         retired        homemaker                retired
                                                                                                                     unemployed                       unemployed
1.  Gross Compensation as Reported on W-2(s). (Enclose W-2s)  . . . . . . . . . . . . .                                                           .00                                            .00 
2.  Unreimbursed Employee Business Expenses. (Enclose PA Schedule UE) . . . .                                                                     .00                                            .00 
3.  Other Taxable Earned Income * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                           .00                                            .00 
4.  Total Taxable Earned Income (Subtract Line 2 from Line 1 and add Line 3)                             . . . .                                  .00                                            .00 

5.  Net Profit (Enclose PA Schedules*) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                              .00                                            .00 
    NON-TAXABLE S-Corp earnings check this box:
6. Net Loss (Enclose PA Schedules*) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                         .00                                            .00 
7. Total Taxable Net Profit (Subtract Line 6 from Line 5.  If less than zero, enter zero)                . .                                      .00                                            .00 
8. Total Taxable Earned Income and Net Profit (Add Lines 4 and 7) . . . . . . . . . . . .                                                         .00                                            .00 
9. Total Tax Liability (Line 8 multiplied by                            ) . . . . . . . . . . . . . . . .                                         .00                                            .00 
10. Total Local Earned Income Tax Withheld (May not equal W-2 - See Instructions)                                                                 .00                                            .00 
11.Quarterly Estimated Payments/Credit From Previous Tax Year . . . . . . . . . . .                                                               .00                                            .00 
12.  Out-of-State, Philadelphia, Act 172 Credits (include supporting documentation)                                                               .00                                            .00 
13. TOTAL PAYMENTS and CREDITS              (Add Lines 10 through 12) . . . . . . . . . . . .                                                     .00                                            .00 
14. Refund  IF MORE THAN $1.00, enter amount (or select option in 15) . . . . . . . .                                                             .00                                            .00 
15. Credit Taxpayer/Spouse (Amount of Line 13 you want as a credit to your account) . . .                                                         .00                                            .00 
     Credit to next year         Credit to spouse
16. EARNED INCOME TAX BALANCE DUE (Line 9 minus Line 13). . . . . . . . . . .                                                                     .00                                            .00 
17. Penalty after April 15*  (multiply Line 16 x 0.01 x # months u paid)n          . . . . . . . . . . .                                          .00                                            .00 
18. Interest after April 15* (multiply Line 16 x 0.000082 x # days n u paid)             . . . . . . .                                            .00                                            .00 
19. TOTAL PAYMENT DUE (Add Lines 16, 17, and 18) . . . . . . . . . . . . . . . . . . . . .                                                        .00                                            .00 
*See Instructions
                                 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.
YOUR SIGNATURE                                                                               SPOUSE’S SIGNATURE (If Filing Jointly)                              DATE (MM/DD/YYYY)
PREPARER’S PRINTED NAME & SIGNATURE                                                                                                                   PHONE NUMBER



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                                                                        TAXPAYER A:
S-CORPORATION PROFIT/LOSS REPORT
To  avoid  future  correspondence,  please  report  any  S  Corporation         ,                                      ,     . 0  0
Pass-Through profits (losses) that were reported on your PA 40 Return.  TAXPAYER B:
LOCAL WORKSHEET (Moved During the Year)                                         ,                                      ,     . 0  0
PART YEAR RESIDENT
Residence #1 ____________________ Dates ________ to ________   Length of Time______________
Residence #2 ____________________ Dates ________ to ________   Length of Time______________
INCOME PRORATION  ( _____________________________________________________________________ )
                                                Residence # 1 COMPLETE ADDRESS
Employer # 1 ___________________

         Local Income  $ _______________ / ____________ 12     X _______________________# of months at this residence= ________________
         Withholding    $ _______________ /  ____________ 12 X _______________________ = ________________
                                                                      # of months at this residence
Employer # 2 ___________________
         Local Income  $ _______________ /  ____________ 12  X _______________________ = ________________
                                                                      # of months at this residence
         Withholding    $ _______________ /  ____________ 12 X _______________________ = ________________
                                                                      # of months at this residence
                   Residence #1             Total Income ____________________ Total Withholding ____________________
INCOME PRORATION  ( _____________________________________________________________________ )
                                                Residence # 2  COMPLETE ADDRESS
Employer # 1 ___________________
         Local Income  $ _______________ / ____________ 12     X _______________________ = ________________
                                                                      # of months at this residence
         Withholding    $ _______________ /  ____________ 12 X _______________________ = ________________
                                                                      # of months at this residence
Employer # 2 ___________________
         Local Income  $ _______________ /  ____________ 12  X _______________________ = ________________
                                                                      # of months at this residence
         Withholding    $ _______________ /  ____________ 12 X _______________________ = ________________
                                                                      # of months at this residence
                   Residence #2             Total Income ____________________ Total Withholding ____________________
LINE 10: LOCAL EARNED INCOME TAX WITHHELD WORKSHEET 
(Complete worksheet if you work in an area where the non-resident tax rate exceeds your home resident rate)
               (1)                 (2)          (3) Home Location     (4) Work Location                                  (5)                                                 (6) Disallowed   (7) Credit Allowed
         Local Wages        Tax Withheld        Resident Rate         Non-Resident Rate                              Col 4 minus Col 3    Withholding Credit                                  For Tax Withheld
         (W2 box 16 or 18)     (W2 box 19)      (See page 1, line 9)  (See Instructions)                         (if less than 0 enter 0)                                    (Col 1 x  Col 5) (Col 2 - Col 6)
Example:           10,000                   130                1.25%            1.30%                                        0.05%                                           5.00                       125.00 
1.
2.
3.
                                                                                                                 TOTAL - Enter this amount on Line 10
                                                             NON-RECIPROCAL STATE WORKSHEET
(See Instructions line 12)
EARNED INCOME:  Taxed in other state as shown on the state tax return.
Enclose a copy of state return or credit will be disallowed ..........................................................................................................      (1)______________________
Local tax 1% or as specified on the front of this form  ....................................................................................................................   X ______________________
                                                                                                                                                                               (2)______________________
Tax Liability Paid to other state(s) ....................................................................................................      (3) ____________________
PA Income Tax (line 1 x PA Income Tax rate for year being reported) ............................................     (4) ____________________
CREDIT to be used against Local Tax
          (Line 3 minus line 4)  On line 12 enter this amount
         or the amount on line 2 of worksheet, whichever is less.   (If less than zero, enter zero) ........................................                                 (5) ____________________
**Additional Addresses:
DATES LIVING AT EACH ADDRESS                    ADDRESS                                                                  TWP OR BORO                                         COUNTY
  /   /   TO           /   /
  /   /   TO           /   /
  /   /   TO           /   /

                                                A NOTE FOR RETIRED AND/OR SENIOR CITIZENS
IF YOU ARE RETIRED AND ARE NO LONGER RECEIVING A SALARY, WAGES OR INCOME FROM A BUSINESS, YOU MAY NOT OWE AN EARNED INCOME TAX.
SOCIAL SECURITY PAYMENTS, PAYMENTS FROM A QUALIFIED PENSION PLAN AND INTEREST AND/OR DIVIDENDS ACCRUED FROM BANK ACCOUNTS AND/OR
INVESTMENTS ARE NOT SUBJECT TO THE LOCAL EARNED INCOME TAX.
IF YOU RECEIVED A LOCAL EARNED INCOME TAX FORM AND ARE RETIRED WITH NO EARNED INCOME, PLEASE CHECK THE APPROPRIATE BOX ON THE
FORM AND RETURN.
IF YOU STILL RECEIVE WAGES FROM A PART-TIME EMPLOYER OR BUSINESS, YOU WILL NEED TO FILE AND PAY THE EARNED INCOME TAX.






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