Form W2-R - Annual Reconciliation Of Earned Income Tax Withheld From Wages
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1
2W2-R Annual Reconciliation of
Earned Income Tax Withheld From Wages
W2
W2R
PO Box 25113
As reported on Employer’s Quarterly Return (Form E-1);
Lehigh Valley, PA 18002-5113
W2R
with income tax withheld as shown on
Withholding Statements (W-2)
Year:
Due by
Last Day of February
Filed Online
*see instructions
Please complete information requested and remit to:
HAB - EMP REC
PO Box 25113
Lehigh Valley, PA 18002-5113
You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and
collection of local taxes by calling Berkheimer at 610-599-3139, during the hours of 8:00 a.m. through 4:00 p.m., Monday
Please see reverse for instructions
through Friday. Or, you can visit our website at
Berkheimer is not the appointed tax hearing officer for your taxing district and will not accept any petitions for appeal.
Employer Name
Petitions for appeal must be filed with the appropriate appeals board for your County. Berkheimer can provide you with the
proper procedures and forms necessary to file an appeal with the appeals board for your Tax Collection District.
City
State
Zip
Municipal Location of Business
PSD Number
Federal ID No.
TCD Filed With
Employer Acct No.
WEB
1. Total number of withholding statements (W-2s) accompanying this report
.
,
( A)
2. Total income tax withheld from all wages during the year as shown on (W-2s)
$
EARNED INCOME TAX
Tax Paid
.
,
Quarter ended March 31 .................... $
.
,
Quarter ended June 30 ...................... $
.
,
Quarter ended September 30 ............ $
.
,
Quarter ended December 31 .............. $
.
,
( B)
3. Total quarterly income tax from wages during the year as reported on Quarterly E-1 Reports
$
.
,
TOTAL
$
.
TOTAL AMOUNT OF
,
ENCLOSED CHECK
4. Any difference between A and B must be explained in attached statement. Where A and B do not agree, please remit or request refund.
I DECLARE UNDER PENALITES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY MEAND TO THE BEST
OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.
Signature_______________________________________________ Phone___________________________ Date_______________
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