Form Qpv - Berks Earned Income Tax Bureau

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BERKS EARNED INCOME TAX BUREAU
920 Van Reed Road, Wyomissing, PA 19610-1700 |
Phone: (610) 372-8439 | Toll Free: (855) 372-8439 | Fax: (610) 372-1102
INSTRUCTIONS FOR FILING QUARTERLY ESTIMATED PAYMENTS
Individuals, who live within the taxing jurisdiction of Berks EIT Bureau, are required to pay, during the
year, an estimated amount for taxes that are not withheld from their employment or for the anticipated net
profits of a business. The due dates for these four payments are the 15th day of the month immediately
after the calendar quarter (April 15, July 15, October 15 and January 15).
The taxpayer’s name, address and social security number must be included with each estimated
payment. If there are any questions regarding this form, please do not hesitate to contact our office at
610-372-8439.
2015
PAYMENT RECORD FOR TAX YEAR
(retain for your records):
QUARTER
DUE BY
DATE PAID
CHECK #
AMOUNT PAID
1
April 15
2
July 15
3
October 15
4
January 15
TOTAL PAID
COMPLETE AND RETURN VOUCHER WITH PAYMENT
LOCAL EARNED INCOME TAX QUARTERLY PAYMENT VOUCHER
TAX YEAR
QPV
BERKS E.I.T. BUREAU | 920 VAN REED ROAD, WYOMISSING, PA 19610-1700
2015
Form
Phone: (610) 372-8439 | Toll Free: (855) 372-8439 | Fax: (610) 372-1102
TAXPAYER A
SPOUSE B
Office Use Only:
Social Security Number
Social Security Number
-
-
-
-
TOTAL PAYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
.
TAXPAYER A - LAST NAME, FIRST NAME, MIDDLE INITIAL
AMOUNT ENCLOSED
.
SPOUSE B - LAST NAME, FIRST NAME, MIDDLE INITIAL
PHYSICAL RESIDENT ADDRESS (NUMBER AND STREET)
CITY, STATE AND ZIP CODE
Make Checks payable to "Berks EIT Bureau"
Please write your full social security number(s) on your check.
There will be a $20.00 fee for checks returned for insufficient funds.

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