CLGS-32-1 (04-16)

                   TAXPAYER ANNUAL
                 LOCAL EARNED INCOME TAX RETURN

                        INSTRUCTIONS
A.  General Instructions
1. WHEN TO FILE:This return must be completed and filed by all persons subject to the tax on or before April 15 (unless the 15th 
is a Saturday or Sunday then file the next business day), regardless of whether or not tax is due. If you file a Federal or State
Application for Extension, check the extension box on the front of the form and send this form along with your estimated payment by
April 15, unless the 15th is a Saturday or Sunday, then by the next business day. If you use a professional tax preparer, confirm that
they will submit your final return for you.
2. WHERE TO FILE:Remit to the local earned income tax collector for every tax collection district in which you lived during the year.
3. EFFECTIVE DATES:January 1 through December 31, unless otherwise noted on your local earned income tax return.
4. AMENDED RETURN:If a taxpayer amends his federal income tax return, an amended local earned income tax return must also be
filed with the local earned income tax collector.
5. RECEIPT / COPY: Your cancelled check is sufficient proof of payment.
6. PENALTY AND INTEREST: If for any reason the tax is not paid when due, penalty and interest will be charged. Any late, incorrect
filing or payment may result in additional costs of collection.
7. ROUND OFF CENTSto the nearest whole dollar. Do not include amounts under 50 cents. Increase amounts from 50 to 99 cents to
the next dollar amount.
8. USE BLACK OR BLUE INK ONLY WHEN COMPLETING THIS FORM.

B.  Regulations/Line by Line Instructions
LINE 1:          GROSS EARNINGS FOR SERVICES RENDERED
   Documentation Required:W-2(S) must be enclosed (legible photocopies are accepted).
   TAXABLE INCOME INCLUDES:Salaries, Wages, Commissions, Bonuses, Tips, Stipends, Fees, Incentive Payments,
   Employee Contributions to Retirement Accounts, Compensation Drawing Accounts (If amounts received as a drawing account
   exceed the salaries or commission earned, the tax is payable on the amounts received. If the employee subsequently repays to
   the employer any amounts not in fact earned, the tax shall be adjusted accordingly.). Benefits Accruing from Employment, such
   as: Annual Leave, Vacation, Holiday, Separation, Sabbatical Leave, Compensation Received in the Form of Property shall be
   taxed at its fair market value at the time of receipt, Jury Duty Pay, Military Pay for Services Other than Active Duty, Sick Pay (if
   employee received a regular salary during period of sickness or disability by virtue of his agreement of employment), and Taxes
   Assumed by the Employer. Taxpayer should refer to the PA Department of Revenue regulations regarding taxable
   compensation. This list is not exhaustive; contact your local earned income tax collector if you have any questions.
   NON-TAXABLE INCOME INCLUDES:Social Security Benefits, Unemployment Compensation, Pensions, Public Assistance,
   Death Benefits, Gifts, Interest, Dividends, Boarding and Lodging to Employees for Convenience of Employer, Lottery
   Winnings, Supplementary Unemployment Benefits (sub pay), Capital Gains (Capital losses may not be used as a deduction
   against other taxable income.), Disability Benefits (periodical payments received by an individual under a disability insurance
   plan), Active Military Service and Summer Encampment, Personal Use of Company Cars, Cafeteria Plans, and Clergy
   Housing Allowance. Some forms of payments from Individual Retirement Programs, such as Keogh, Tax Shelter Annuity, IRA,
   and 401K are not taxable. Taxpayer should refer to the PA Department of Revenue regulations regarding taxable
   compensation. This list is not exhaustive; contact your local earned income tax collector if you have any questions.
LINE 2:          ALLOWABLE EMPLOYEE BUSINESS EXPENSES
   Documentation Required:Pennsylvania form PA-UE must be enclosed (legible photocopies are accepted).
LINE 3:          OTHER TAXABLE EARNED INCOME:Include income, from work or services performed, which has not been included on line
   1 or line 5. Do not include interest, dividends or capital gains.
LINE 4:          TOTAL TAXABLE EARNED INCOME:Subtract line 2 from line 1 and add line 3.
LINES 5 & 6: NET PROFITS/NET LOSSES FROM BUSINESS:Use line 5 for profit and line 6 for loss.
   Documentation Required:1099(s), PA schedules C, E, F, or K-1 must be enclosed (legible photocopies are accepted).
   Rule: A taxpayer may NOT offset a business loss against wages and other compensation (W-2 earnings -- line 1). "Pass-
   through" income from an S-Corporation is NOT taxable and loss is not deductible. A taxpayer may offset a loss from one
   business entity against a net profit from another business entity.
LINE 7:          TOTAL TAXABLE NET PROFIT: Subtract line 6 from line 5; if less than zero, enter zero.

CLGS-32-1 (04-16)                                                                                                                 Instructions

LINE 8:           TOTAL TAXABLE EARNED INCOME AND NETAddPROFIT:lines 4 & 7.
LINE 9:           TAX LIABILITY: Multiply line 8 by your local earned income tax rate. If you don’t know your rate, contact your local earned
        income tax collector where you live or visit www.newPA.com to find your rate.
LINE 10:  EARNED INCOME TAX WITHHELD:If you work in an area that taxes non-residents at a higher rate than the resident rate
        where you live, you may not be able to claim the entire amount of tax withheld on your W-2's.  If this is the case
        complete the worksheet on the back of the Final Return Form to calculate the amount of income tax withheld to enter on Line
        10 of the Final Return. thenIf thiscombineis not thethecase,amount of tax withheld as reported in box 19 of your W-2's and
        report that amount on Line 10 of the Final Return. To determine if you work in an area that has a Non-Resident Tax Rate that
        exceeds the resident rate where you live, contact your employer or visit: http://munstatspa.dced.state.pa.us/FindLocalTax.aspx
LINE 11: QUARTERLY ESTIMATED PAYMENTS/ CREDIT FROM PREVIOUS YEAR/ PAYMENTS MADE WITH EXTENSION OR
        ADDITIONAL PAYMENTS: List any quarterly estimated tax payments made to date for the appropriate filing year (do not include
        any penalty or interest amounts that may have been paid with the quarterly payments.) Also include the tax credit from the prior
        year AND any additional payments made for the filing year, including any amount paid with when requesting an extension. 
        NOTE: Taxpayers who expect to have net profits or wages not subject to withholding must report and timely pay quarterly
        estimated tax payments. Form CLGS-32 is used to report the income and pay the tax each quarter and credit may be claimed
        on this line for any such advance payments of tax.
LINE 12:  OUT-OF-STATE OR PHILADELPHIA CREDITS (include supporting documentation)
        General Rules Applicable to All Line 12 Credits:
        (1)       Credits for income taxes paid to other states must first be used against your Pennsylvania state income tax liability; any
           credit remaining thereafter may be used against your local earned income tax liability.
        (2)       Credits for income taxes paid to political subdivisions located outside of Pennsylvania or for wage taxes paid to
           Philadelphia may be taken directly against your local earned income tax liability.
        (3)       In calculating your credit for income taxes paid to another state or to a political subdivision, note that the same items of
           income must be subject to both your local earned income tax and the out-of state tax.
        (4) No credit for income taxes paid to another state or political subdivision may exceed your total local earned
           income tax liability.
        Credit for Taxes Paid to Other States:You may take a credit based upon the gross earnings taxed both in another state and
        in Pennsylvania that is in excess of the Pennsylvania state personal income tax rate. THIS CREDIT WILL BE DISALLOWED
        IF THE NON-RESIDENT STATE RETURN AND THE DOCUMENT SHOWING STATE INCOME TAX WITHHELD ARE NOT
        PROVIDED (W-2, K-1, Etc.).
        No credits are given for state income tax withheld from an employee who works in a state that has a reciprocal
        agreement with the Commonwealth of Pennsylvania (Maryland, New Jersey, Ohio, Virginia, West Virginia, and Indiana). 
        Example:Taxpayer earned wages of $10,000.00 in Delaware and paid an income tax liability to that state of $317.00.
        Assuming the current Pennsylvania state tax rate is 3.07% for the tax year in question, since the $317.00 exceeds 3.07% 
        (PA Tax) amount of $307.00 by $10.00, the $10.00 may be credited against your local income tax.

                        Gross Income  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(1) $10,000.00
                        Local Tax 1% x .01  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x.01
                                                                                              (2)        100.00
                        Tax paid to Delaware  . . . . . . . . . . . . . . . . . . . . . . .(3)        317.00
                        PA Income Tax (3.07% x $10,000.00)   . . . . . . . . . .(4)        307.00
                        Credit to be used against Local Tax
                        (Line 3 minus Line 4)
                        On Line 12 of the tax return, enter this amount . . . .(5)         10.00
                        or the amount on Line 2 of worksheet,
                        whichever is less
        If all your wages or gross earnings are subject to Delaware State Income Tax (not PA), use the above example to calculate
        your tax obligation. If you had earned income NOT taxed by Delaware, this income would be subject to the earned income tax
        effective where you live and must be shown separately on the Local Earned Income Tax Return.
        Credit for Taxes Paid to Political Subdivisions Outside of Pennsylvania:You may take a credit based upon the gross
        earnings taxed in both another political subdivision and where you live in Pennsylvania. THIS CREDIT WILL BE
        DISALLOWED IF THE FOREIGN CITY RETURN AND OR YOUR W-2 FORM SHOWING CITY INCOME TAX WITHHELD IS
        NOT PROVIDED.

CLGS-32-1 (04-16)                                                        Instructions

Credit for Taxes to Philadelphia: You may use any wage tax paid to Philadelphia as a credit toward your local earned
income tax liability. You must complete the Local Earned Income Tax Return. A COPY OF YOUR W-2 AND/OR
VERIFICATION OF TAXES PAID MUST BE ENCLOSED WITH THE FORM OR CREDIT WILL BE DISALLOWED. No refunds
or credits will be allowed for any overpayment made to Philadelphia. On line 12 of the tax return, enter the amount of
Philadelphia wage tax paid.
LINE 13:  TOTAL PAYMENTS AND CREDITS: Enter the sum of lines 10, 11 & 12.
LINE 14:  REFUND:If tax (line 9) is less than your credits (line 13), enter amount of refund. If you have an overpayment of taxes in
excess of $1.00, you may elect to receive a refund or take same as credit against the next year's tax liability. A 1099 will be
issued to the Federal Government for any credit or refund in excess of $10.00.
LINE 15:  CREDIT: If tax (line 9) is less than your credits (line 13) enter amount of credit and check the applicable box for credit to
spouse or credit to next year. A 1099 will be issued to the Federal Government for any credit or refund in excess of $10.00.
LINE 16:  AMOUNT OF TAX DUE: If tax (line 9) is larger than your credits (line 13), enter amount of tax due, if less than $1.00, 
ENTER ZERO.
LINE 17 & 18: INTEREST AND PENALTIES: If for any reason the tax is not paid when due, interest and penalty of the unpaid tax for
each month shall be added and collected. Returns received after the due date may be charged additional costs of collection.
LINE 19:  TOTAL AMOUNT DUE:The sum of lines 16, 17 & 18. OMIT IF LESS THAN $1.00.
Note: All accounts are subject to audit and review. Local or city copy of W-2 and/or supporting schedules must be enclosed
with tax return.
(Legible photocopies of W-2s and schedules are accepted).

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 ADDRESSSTREET ADDRESS (No PO Box, RD or RR)CITY OR POST OFFICESTATE                                                                                      ZIP
    /     /    TO/     /
    /     /     TO/     /
                                                                                                                                           **If you need additional space - please see back of form.
LAST NAME, FIRST NAME, MIDDLE INITIAL                SPOUSE’S LAST NAME, FIRST NAME, MIDDLE INITIAL

STREET ADDRESS (PONoBox, RD or RR)

SECOND LINE OF ADDRESS

CITY                                                                                                   STATE                               ZIP CODE 

DAYTIME PHONE NUMBER                                                  RESIDENT PSD CODE
                                                                                                                         EXTENSION AMENDED RETURNNON-RESIDENT

                                                                                                                         Social Security #          Spouse’s Social Security #
The calculations reported in the first column MUST pertain to the name printed
    in the column, regardless of whether the husband or wife appears first. 
                       Combining income is NOT permitted.If you had NO EARNED INCOME,If you had NO EARNED INCOME,
                                                                                                                         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 or Philadelphia 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  by                    )                 . . . . . . . . . . . . . . . .                     .00                       .00 
18.Interest after April 15* (multiply Line 16  by                    ) . . . . . . . . . . . . . . . . .                                   .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

                                                                           TAXPAYER A:
S-CORPORATION PROFIT/LOSS REPORT                                                                                                  0   0
To  avoid  future  correspondence,  please  report  any  S  Corporation             ,                                      ,     .
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  ( _____________________________________________________________________ )
Employer # 1 ___________________                      Residence # 1 COMPLETE ADDRESS

         Local Income  $ _______________ / ____________ 12           X _______________________ = ________________
                                                                           # of months at this residence
         Withholding    $ _______________ /  ____________ 12       X _______________________ = ________________
Employer # 2 ___________________                                           # of months at this residence
         Local Income     $ _______________ /  ____________ 12       X _______________________ = ________________
         Withholding      $ _______________ /  ____________ 12     X _______________________# of months at this residence= ________________
                                                                           # 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.