Wilkins Registration Form - Township Of Wilkins
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1TOWNSHIP OF WILKINS
Account #
_________________
BUSINESS REGISTRATION
Incomplete forms will be rejected
The taxes levied by the Township of Wilkins Municipal Code require anyone engaged in any
business activity to register by providing the following information:(type/print legibly)
Name Doing Business as
Local # (
)
Owner of Business
Fax # (
)
Business Address in Wilkins Township
(Use employee address if working from home)
Select type of business entity:
Individual
Partnership
LLC/Corp.
Other ___ provide description
Federal Tax Identification Number
DATE BUSINESS OPENED IN Wilkins Township
(MONTH/DAY/YEAR)
Number of Employees at Wilkins Township Location
Description of Business Activities attributable to Wilkins Township location:
_______________________________
Mercantile or Business Privilege License and Tax form mailing address:
Attention:
Title:
Phone #
____
Email address: ________________________________________ Fax #
________
Local Services Tax form address: (Complete only if different than other addresses)
Attention:
Title:
Phone #
____
Email address: ________________________________________ Fax #
________
Name, Social Security Number, & Residence Address of Individual Owners, Partners,
Corporate Officers:
(attach list if necessary)
Name
SS #
-
-
Title
Address
Certification:
I hereby certify that the information contained herein is true,
correct and complete to the best of my knowledge.
Signature:
Title:
Date:
/
/
NOTE:
ANY CHANGES TO THE INFORMATION GIVEN HEREIN MUST BE READILY REPORTED TO
THE BUSINESS TAX OFFICE TO ENSURE PROPER FILING OF RETURNS.
Return to: Business Tax Office 2700 Monroeville Blvd. Monroeville, PA 15146-2388
Direct inquiries to:
montax@monroeville.pa.us
Fax 412-856-1054 or Telephone 412-856-3347
Earned Income Tax: Employer withholding is now mandatory for anyone working in PA. Payments
must be made quarterly including self employed individuals. For only the earned income tax
contact Keystone Collections Group 546 Wendel Rd, Irwin PA 15642
724
978 0300.
Contact PA Municipal Service 412 829-0567 for 2011 and prior year EIT.
TAX OFFICE USE: Bus Industry #____________ BUS RTN
LIC
LST
DATE
/
/
INITIALS
8/21/2014
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