*Address*City*State*Zip Code*E-mail Address*Social Security Number(Last 4 Digits)Township, Boro, CitySchool District*Telephone NumberHow long have you lived at the above address?FromToIf you have lived at the above address less than 2 years,Previous Street AddressPrevious CityPrevious StatePrevious Zip CodeIndividual File Maintenance FormEmployment JurisdictionResident JurisdictionTownship, Boro, CitySchool DistrictDoes your employer withhold the Local Earned Income Tax from your pay?Do you own your own business?If you have no income at this time, please specify.Other (Please specify)CountyCounty*Name(###-###-####)Please Tab from field to field, do not Enter.
BERK-E ON-LINE SHORTER . FASTER... E-XACTLY. ®If you have a spouse, please continue. If not, please click Submit now.Spouse's NameSpouse's Social Security Number (Last 4 Digits)How long has your spouse lived at the address listed above?FromToIf your spouse lived at the address listed above for less than 2 years,Spouse's Previous Street AddressSpouse's Previous CitySpouse's Previous StateSpouse's Previous Zip CodeSpouse's Employment JurisdictionTownship, Boro, CitySchool DistrictCountyDoes your spouse's employer withhold the Local Earned Income Tax from their pay?Does your spouse own their own business?If your spouse has no income at this time, please specify.Other (Please specify)BERK-E ON-LINE SHORTER . FASTER... E-XACTLY. ® YearYearYearYear