Form Mag-1 - Transmitter Report - Magnetic Media Reporting Of W-2 Information To Ctcb
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FORM MAG-1 TRANSMITTER REPORT
MAGNETIC MEDIA REPORTING OF W-2 INFORMATION TO
CAPITAL TAX COLLECTION BUREAU (CTCB)
Instructions: Complete this form and return it along with the magnetic media and Form 512
(Employer's EIT Reconciliation) to:
CAPITAL TAX COLLECTION BUREAU
2301 N 3RD ST
HARRISBURG PA 17110-1893
Note: All magnetic media reports should be forwarded to our Harrisburg Division even if
withholding taxes are remitted to our Carlisle or Central Dauphin Divisions. If more than one
employer will be reported on the same media file, please complete page 2 of this form in lieu of
completing item numbers 1, 2, and 7 below.
1. Federal EIN and CTCB issued employer numbers (if different):
Federal EIN Number ________________
CTCB Employer Number (if different) ________________
2. Full name and mailing address of employer:
________________________________________
________________________________________
________________________________________
________________________________________
3.
Tax year of data being submitted ________
4. Person to contact regarding this magnetic media report:
Name: ____________________________
Title: __________________
Company: ____________________________
Telephone: __________________
5. Type of equipment on which media was prepared:
Main Frame
Media Drive
Manufacturer: ________________________
____________________
Model Number: ________________________
____________________
6. If submitting data on magnetic tape, identify the tape density and recording code used:
_____ 1600 BPI
_____ ASCII
DENSITY & RECORDING MODE:
RECORDING CODE:
_____ 6250 BPI
_____ EBCDIC
(MUST BE 9 TRACKS)
7. No. of employees being reported on this magnetic media: _______
8. Name and address of person and organization to which media should be returned:
________________________________________
________________________________________
________________________________________
________________________________________
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