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Get and Sign Taxpayer Annual Local Earned Income Tax Return Form 2021-2022
Municipality (enter PSD Code for each jurisdiction). Use Part-Year Resident Schedule on back to calculate income and taxes for each return.
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
STATE
CITY OR POST OFFICE
DAYTIME PHONE NUMBER
ZIP CODE
RESIDENT PSD CODE
The calculations reported in the first column MUST pertain to the name
printed in the column, regardless of...
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