Income-based Wage Tax Refund Petition

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Applicant information
Employee name*

First nameLast name
Social Security number*
Email*
example@example.com
Phone number*
Are you a resident of Philadelphia?*

YesNo
Home address*

Street address

Street address line 2

CityState

Postal / ZIP Code
Re-enter your home address to verify it is correct*

Street address

Street address line 2

CityState

Postal / ZIP Code

* Required

Tax year 2020 information
Filing status

Single/Separated/DeceasedMarried, filing separately
Number of dependents
Total eligibility income *
PA Schedule SP 40, line 11
Upload PA Schedule SP 40*

Browse files

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Number of W-2s attached*
Maximum 4
Upload W-2s*

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Calculate your resident refund

This section is for Philadelphia residents only. If you are not a Philadelphia resident, return to the previous page and select "No" to the question “Are you a resident of Philadelphia?”

If you are approved for Pennsylvania tax forgiveness (PA Schedule SP 40), you may also be entitled to receive a refund of City Wage Tax withheld by your employer.

Please enter your 2020 W-2 information below. Do not include your spouse’s W-2 information. If you have more than four W-2s, you must fill out a paper form.

* Required
- Employer details
- Employer 1 identification number (EIN)*
  W-2 box b
- 1. Philadelphia resident wages earned Jan. 1, 2020 – June 30, 2020 for employer 1
- 2. Resident income-based Wage Tax due for employer 1
  Field 1 x Tax rate (0.033712)
- 3. Philadelphia resident wages earned July 1, 2020 – Dec. 31, 2020 for employer 1
- 4. Resident income-based Wage Tax due for employer 1
  Field 3 x Tax rate (0.015)
- 5. Total resident income-based Wage Tax due for employer 1
  Field 2 + Field 4
- 6. Wage Tax withheld for employer 1
  W-2 box 19
- 7. Refund due for employer 1
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Resident refund due" is zero, no further action is needed.
  - If the amount in "7. Resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Employer 2 details
- Employer 2 identification number (EIN)*
  W-2 box b
- 1. Philadelphia resident wages earned Jan. 1, 2020 – June 30, 2020 for employer 2
- 2. Resident income-based Wage Tax due for employer 2
  Field 1 x Tax rate (0.033712)
- 3. Philadelphia resident wages earned July 1, 2020 – Dec. 31, 2020 for employer 2
- 4. Resident income-based Wage Tax due for employer 2
  Field 3 x Tax rate (0.015)
- 5. Total resident income-based Wage Tax due for employer 2
  Field 2 + Field 4
- 6. Resident Wage Tax withheld for employer 2
  W-2 box 19
- 7. Resident refund due for employer 2
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Resident refund due" is zero, no further action is needed.
  - If the amount in "7. Resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Employer 3 details
- Employer 3 identification number (EIN)*
  W-2 box b
- 1. Philadelphia resident wages earned Jan. 1, 2020 – June 30, 2020 for employer 3
- 2. Resident income-based Wage Tax due for employer 3
  Field 1 x Tax rate (0.033712)
- 3. Philadelphia resident wages earned July 1, 2020 – Dec. 31, 2020 for employer 3
- 4. Resident income-based Wage Tax due Jul. 1, 2020 - Dec. 31, 2020 for employer 3
  Field 4 x Tax rate (0.015)
- 5. Total resident income-based Wage Tax due for employer 3
  Field 2 + Field 4
- 6. Resident Wage Tax withheld for employer 3
  W-2 box 19
- 7. Resident refund due for employer 3
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Resident refund due" is zero, no further action is needed.
  - If the amount in "7. Resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Employer 4 details
- Employer 4 identification number (EIN)*
  W-2 box b
- 1. Philadelphia resident wages earned Jan. 1, 2020 – June 30, 2020 for employer 4
- 2. Resident income-based Wage Tax due for employer 4
  Field 1 x Tax rate (0.033712)
- 3. Philadelphia resident wages earned July 1, 2020 – Dec. 31, 2020 for employer 4
- 4. Resident income-based Wage Tax due for employer 4
  Field 3 x Tax rate (0.015)
- 5. Total resident income-based Wage Tax due for employer 4
  Field 2 + Field 4
- 6. Resident Wage Tax withheld for employer 4
  W-2 Box 19
- 7. Resident refund due for employer 4
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Resident refund due" is zero, no further action is needed.
  - If the amount in "7. Resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Total resident refund from all employers
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "Total refund from all employers" is zero, no further action is needed.
  - If the amount in "Total refund from all employers" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.

Calculate your non-resident refund

This section is for non-residents of Philadelphia only, if you are a Philadelphia resident please return to the previous page and select Yes to the question “Are you a resident of Philadelphia?”

If you are approved for Pennsylvania tax forgiveness (PA Schedule SP 40), you may also be entitled to receive a refund of City Wage Tax withheld by your employer.

Please enter your 2020 W-2 information in the worksheet below. Do not include your spouse’s W-2 information. If you have more than four W-2s, please see instructions, you must fill out a paper form.
- Employer details
- Employer 1 identification number (EIN)*
  W-2 box b
- 1. Philadelphia wages earned Jan. 1, 2020 – June 30, 2020 for employer 1
- 2. Non-resident income-based Wage Tax due
  Field 1 x Tax rate (0.029481)
- 3. Philadelphia wages earned July 1, 2020 – Dec. 31, 2020 for employer 1
- 4. Non-resident income-based Wage Tax due for employer 1
  Field 3 x Tax rate (0.015)
- 5. Total income-based Wage Tax due for employer 1
  Field 2 + Field 4
- 6. Wage Tax withheld for employer 1
  W-2 box 19
- 7. Non-resident refund due for employer 1
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Non-resident refund due" is zero, no further action is needed.
  - If the amount in "7. Non-resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Employer 2 details
- Employer 2 identification number (EIN)*
  W-2 box b
- 1. Philadelphia wages earned Jan. 1, 2020 – June 30, 2020 for employer 2
- 2. Non-resident income-based Wage Tax due for employer 2
  Field 1 x Tax rate (0.029481)
- 3. Philadelphia wages earned July 1, 2020 – Dec. 31, 2020 for employer 2
- 4. Non-resident income-based Wage Tax due for employer 2
  Field 3 x Tax rate (0.015)
- 5. Total income-based Wage Tax due for employer 2
  Field 2 + Field 4
- 6. Wage Tax withheld for employer 2
  W-2 box 19
- 7. Non-resident refund due for employer 2
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Non-resident refund due" is zero, no further action is needed.
  - If the amount in "7. Non-resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Employer 3 details
- Employer 3 identification number (EIN)*
  W-2 box b
- 1. Philadelphia wages earned Jan. 1, 2020 – June 30, 2020 for employer 3
- 2. Non-resident income-based Wage Tax due for employer 3
  Field 1 x Tax rate (0.029481)
- 3. Philadelphia wages earned July 1, 2020 – Dec. 31, 2020 for employer 3
- 4. Non-resident income-based Wage Tax due for employer 3
  Field 3 x Tax rate (0.015)
- 5. Total income-based Wage Tax due for employer 3
- 6. Wage Tax withheld for employer 3
  W-2 box 19
- 7. Non-resident refund due for employer 3
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Non-resident refund due" is zero, no further action is needed.
  - If the amount in "7. Non-resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Employer 4 details
- Employer 4 identification number (EIN)*
  W-2 box b
- 1. Philadelphia wages earned Jan. 1, 2020 – June 30, 2020 for employer 4
- 2. Non-resident income-based Wage Tax due for employer 4
  Field 1 x Tax rate (0.029481)
- 3. Philadelphia wages earned July 1, 2020 – Dec. 31, 2020 for employer 4
- 4. Non-resident income-based Wage Tax due for employer 4
  Field 3 x Tax rate (0.015)
- 5. Total income-based Wage Tax due for employer 4
  Field 2 + Field 4
- 6. Wage Tax withheld for employer 4
  W-2 box 19
- 7. Non-resident refund due for employer 4
  Field 6 - Field 5
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Non-resident refund due" is zero, no further action is needed.
  - If the amount in "7. Non-resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.
- Total non-resident refund from all employers
- No Refund Available.
  
  Based on the information you provided, no refund is available.
  - If the amount in "7. Non-resident refund due" is zero, no further action is needed.
  - If the amount in "7. Non-resident refund due" is negative, you owe the City additional City Earnings tax. Please file an Earnings Tax return on phila.gov.

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Applicant information

Tax year 2020 information

Calculate your resident refund

Employer details

Employer 2 details

Employer 3 details

Employer 4 details

Calculate your non-resident refund

Employer details

Employer 2 details

Employer 3 details

Employer 4 details

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