Form S527 "Request for Exemption From Per Capita Tax - North Schuylkill School District" - Pennsylvania

What Is Form S527?

This is a legal form that was released by the Berkheimer Tax Administrator - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 6, 2018;
  • The latest edition provided by the Berkheimer Tax Administrator;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form S527 by clicking the link below or browse more documents and templates provided by the Berkheimer Tax Administrator.

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Download Form S527 "Request for Exemption From Per Capita Tax - North Schuylkill School District" - Pennsylvania

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NORTH SCHUYLKILL SCHOOL DISTRICT
REQUEST FOR EXEMPTION FROM PER CAPITA TAX
FOR THE CURRENT SCHOOL YEAR
Please print all items except signature:
YEAR________________
WARD_______________________________
Man Married ________ Man Single _________
Woman Married ________ Woman Single _________
_____________________________________
_____________________________________
First Name
Last Name
First Name
Last Name
_____________________________________
_____________________________________
Street
City
Street
City
______________
______________
Age
Age
Disability, if any ________________________
Number of dependents in addition to persons named
above ______
Property Owner
Yes
No
Are you dependent on another person for support?
Employed
Yes
No
Yes
No
Employer Name ______________________________
Employer Address ____________________________
If married, show joint income on the following items:
I hereby give my permission to the responsible authorities
INCOME FROM:
to verify the listed information:
SOCIAL SECURITY 
$__________________
BLACK LUNG
$__________________
SIGNATURE__________________________________
PENSIONS
$__________________
SOCIAL SECURITY NO. ________________________
OTHER SOURCES* 
$__________________
DATE ______________________________
TOTAL ANNUAL INCOME 
$__________________
SIGNATURE___________________________________
SOCIAL SECURITY NO. ________________________
DATE _____________________________
* Students are reminded that summer income must be reported.
If married, couple must sign.
**You must notify the tax office of any change in financial status.
***Income information may be substantiated from the Bureau of Social Security as a result of a release signed by the applicant
for exemption.
Sworn and subscribed to before me this ______________ day of _______________________
(month, year)
Signature ___________________________________________________________________
Seal
My commission expires ________________________ (date)
INCOME SCALE TO DETERMINE ELIGIBILITY FOR EXEMPTION FROM PER CAPITA TAX
Under Age 65
AGE 65 AND OVER
NUMBER
INCOME
NUMBER
INCOME
IN FAMILY
NOT EXCEEDING
IN FAMILY
NOT EXCEEDING
1
$3,000
1
$2,300
2
$4,000
2
$2,800
3
$4,500
3
$3,300
Please return this form on or before August 31, along with required copy of proof to:
Berkheimer Tax Innovations
PO Box 25144
Lehigh Valley, PA 18002-5144
S527 070618
NORTH SCHUYLKILL SCHOOL DISTRICT
REQUEST FOR EXEMPTION FROM PER CAPITA TAX
FOR THE CURRENT SCHOOL YEAR
Please print all items except signature:
YEAR________________
WARD_______________________________
Man Married ________ Man Single _________
Woman Married ________ Woman Single _________
_____________________________________
_____________________________________
First Name
Last Name
First Name
Last Name
_____________________________________
_____________________________________
Street
City
Street
City
______________
______________
Age
Age
Disability, if any ________________________
Number of dependents in addition to persons named
above ______
Property Owner
Yes
No
Are you dependent on another person for support?
Employed
Yes
No
Yes
No
Employer Name ______________________________
Employer Address ____________________________
If married, show joint income on the following items:
I hereby give my permission to the responsible authorities
INCOME FROM:
to verify the listed information:
SOCIAL SECURITY 
$__________________
BLACK LUNG
$__________________
SIGNATURE__________________________________
PENSIONS
$__________________
SOCIAL SECURITY NO. ________________________
OTHER SOURCES* 
$__________________
DATE ______________________________
TOTAL ANNUAL INCOME 
$__________________
SIGNATURE___________________________________
SOCIAL SECURITY NO. ________________________
DATE _____________________________
* Students are reminded that summer income must be reported.
If married, couple must sign.
**You must notify the tax office of any change in financial status.
***Income information may be substantiated from the Bureau of Social Security as a result of a release signed by the applicant
for exemption.
Sworn and subscribed to before me this ______________ day of _______________________
(month, year)
Signature ___________________________________________________________________
Seal
My commission expires ________________________ (date)
INCOME SCALE TO DETERMINE ELIGIBILITY FOR EXEMPTION FROM PER CAPITA TAX
Under Age 65
AGE 65 AND OVER
NUMBER
INCOME
NUMBER
INCOME
IN FAMILY
NOT EXCEEDING
IN FAMILY
NOT EXCEEDING
1
$3,000
1
$2,300
2
$4,000
2
$2,800
3
$4,500
3
$3,300
Please return this form on or before August 31, along with required copy of proof to:
Berkheimer Tax Innovations
PO Box 25144
Lehigh Valley, PA 18002-5144
S527 070618