Form Em-1 Emergency & Municipal Services Tax 2006 printable pdf download

Form Em-1 Emergency & Municipal Services Tax 2006

EM-1 2006

EMERGENCY & MUNICIPAL

SERVICES TAX

CFD

For Employers & Self-Employed Individuals

City of Pittsburgh

Rev 09/05 FOR OFFICIAL USE ONLY

Amended Return ( )

Tax Return No Longer Needed ( )

CITY ID

FEDERAL ID

SIGNATURE _____________________________________________

TAX PERIOD

Due on or before

TITLE _____________________ DATE _______________________

PHONE _________________________________________________

E-MAIL ADDRESS ________________________________________

PREPARER’S NAME ______________________________________

PREPARER’S PHONE ______________________________________

I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and

belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the

penalties provided by law.

Make name/address corrections above

OMISSION OF THE ABOVE APPLICABLE INFORMATION

USE BLACK INK ONLY ON THIS FORM

CONSTITUES AN INCOMPLETE RETURN

EMERGENCY & MUNICIPAL SERVICES TAX IS $52.00 PER EMPLOYEE, PER YEAR

1. NUMBER OF EM-2s REPORTED

This includes employees, sole proprietor and partners.

2. GROSS AMOUNT OF TAX - LINE 1 MULTIPLIED BY $52.00

You must include explanation, below, if payment is not a multiple of $52.00

3. PENALTY AND INTEREST IS 6% PER MONTH, IF APPLICABLE

Penalty per Month 5% (0.05) (Maximum 50%), Interest per Month 1% (0.01)

TOTAL PAYMENT THIS MONTH - ADD LINES 2 & 3

If no payment is due DO NOT send in this form.

Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH

Mail to: CITY TREASURER EM-1 TAX – PO BOX 642606 – PITTSBURGH PA 15264-2606

You must include explanation, below, if payment is not a multiple of $52.00

A $30.00 fee will be assessed for any check returned from the bank for any reason.

EMERGENCY & MUNICIPAL SERVICES TAX (EM-1)

SECTION B – EXPLANATION – If payment is not in multiples of $52.00, you MUST include an

explanation to avoid penalty and interest charges.

If necessary attach additional sheets

Form Em-1 Emergency & Municipal Services Tax 2006