Form Clgs-32-5 - Employer Quarterly Return Local Earned Income Tax Withholding - 2013 Page 2

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EMPLOYER QUARTERLY RETURN for Local Earned Income Tax Withholding
CLGS-32-5 (06-13)
Employer Business Location: ___________________________________________________________________________ Year and Quarter: ______________
(13) GROSS 
(14) AMOUNT OF EIT
(15) RESIDENT
(11) EMPLOYEE’S SOCIAL 
(12) EMPLOYEE’S NAME/ADDRESS
COMPENSATION PAID
WITHHELD THIS
SECURITY NUMBER
PSD CODE
THIS QUARTER
QUARTER
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