For Employers and Self-Employed Individuals
City of Pittsburgh
School District of Pittsburgh
FOR OFFICIAL USE ONLY
( ) Amended Return
Due on or before
Preparer’ s Name (Print)
I hereby certify, swear and aver that all statements herein are true and correct to
the best of my knowledge and belief, being duly appraised of my duty under the law
to submit honest and complete information or be subject to the penalties provided
1. NUMBER OF OT-2s REPORTED
This includes employees, sole proprietor and partners.
2. GROSS AMOUNT OF TAX - LINE 1 MULTIPLIED BY $10.00
All payments should be in multiples of $10.00. You must include explanation if payment is not a multiple of $10.00.
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 QUARTER - ADD LINES 2 & 3
Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH
Mail to: CITY OF PITTSBURGH OCCUPATION TAX – PO BOX 642606 – PITTSBURGH PA 15264-2606
A $20.00 fee will be assessed for any check returned from the bank for any reason.
MAKE CORRECTIONS BELOW
HAS YOUR BUSINESS DISCONTINUED OR HAVE YOU RELOCATED OUTSIDE THE CITY OF PITTSBURGH?
If yes, a Business Discontinuation Form MUST be completed and returned for processing.
Form(s) can be downloaded at
or call 412-255-2510 to request the form.
NAME AND ADDRESS CORRECTION:
Name_____________________________________________ ____________________________Telephone Number____________________________
Address _________________________________________________________________Federal ID Number _________________________