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CLGS-32-1 (12-18)
LOCAL EARNED INCOME TAX RETURN
LANCASTER COUNTY TAX COLLECTION BUREAU TAX YEAR
1845 William Penn Way Suite 1 • Lancaster, PA 17601-6713
e-file at https://efile.lctcb.org Phone (717) 569-4521 • www.lctcb.org
You are entitled to receive a wrtten explanation of your rights with regard to the audit, appeal, enforcement, refund and collection of local taxes. Contact your Tax Officer.
DATES LIVING AT EACH ADDRESS STREET ADDRESS (No PO Box, RD or RR) CITY OR POST OFFICE STATE ZIP
/ / TO / /
/ / TO / /
If you moved during the tax year, use Part-Year Resident Schedule on reverse side to calculate income and taxes.
LAST NAME, FIRST NAME, MIDDLE INITIAL SPOUSE’S LAST NAME, FIRST NAME, MIDDLE INITIAL
STREET ADDRESS (No PO box, RD or RR) COUNTY
SECOND LINE OF ADDRESS SCHOOL DISTRICT
CITY OR POST OFFICE STATE ZIP CODE MUNICIPALITY
E-MAIL ADDRESS RESIDENT PSD CODE
EXTENSION REQUEST AMENDED RETURN
Social Security # Spouse’s Social Security #
The calculations reported in the first column MUST pertain to the name
printed in the column, regardless of which spouse appears first.
Combining income is NOT permitted. If you had NO EARNED INCOME If you had NO EARNED INCOME
USE ONLY BLACK OR BLUE INK TO COMPLETE THIS FORM check the reason why: check the reason why:
Disabled Student Disabled Student
Deceased Military Deceased Military
Single Married, Filing Jointly Married, Filing Separately Homemaker Retired Homemaker Retired
Unemployed Unemployed
1 Gross compensation as reported on W-2(s) (enclose W-2s) 1
0 0 0 0
2 Unreimbursed Employee Business Expenses (enclose PA Schedule UE) 2
0 0 0 0
3 Other Taxable Earned Income (see Instructions; enclose supporting documents) 3
0 0 0 0
4 Total Taxable Earned Income (subtract Line 2 from Line 1 and add Line 3) 4
0 0 0 0
Net Profits (enclose PA Schedules)
5 NON-TAXABLE S-CORP earnings check this box (enclose S-Corp Schedule) 0 0 5 0 0
6 Net Loss (enclose PA Schedules) 6
0 0 0 0
7 Total Taxable Net Profit (subtract Line 6 from Line 5; if less than zero, enter zero) 7
0 0 0 0
8 Total Taxable Earned income and Net Profit (add Line 4 and Line 7) 8
0 0 0 0
9 Total Tax Liability (Line 8 multiplied by ____ ____ ____. %) 9
0 0 0 0
10 Total Income Tax Withheld (may not equal W-2; see Instructions) 10
0 0 0 0
11 Quarterly and Extension Payments/Credit From Previous Year 11
0 0 0 0
12 Credits: Out-of-State, Philadelphia (enclose supporting documents) 12
0 0 0 0
13 TOTAL PAYMENTS and CREDITS (add Lines 10, 11, and 12) 13
0 0 0 0
14 Refund: enter if more than $1; or select credit option in Line 15 14
0 0 0 0
15 Credit to Taxpayer/Spouse if more than $1, apply credit as follows
Credit to next year Credit to spouse 0 0 15 0 0
16 EARNED INCOME TAX BALANCE DUE (Line 9 minus Line 13 16
0 0 0 0
17 Penalty after April 15 (see instructions) 17
0 0 0 0
18 Interest after April 15 (see instructions) 18
0 0 0 0
19 TOTAL PAYMENT DUE (add Lines 16, 17 and 18) Payable to “LCTCB” 19
0 0 0 0
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 AND SIGNATURE PHONE NUMBER
