Form Eq-1/form El-1 -Employer Quarterly Earned Income Tax List - 2011 Page 2

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EMPLOYER QUARTERLY EARNED INCOME TAX LIST
EL-1
FORM
To electronically file your quarterly withholding, go to
Employer Account #
Employment Location:
Name
Address
Make checks payable to
City
Keystone Collections Group
State
546 Wendel Road
&
Irwin, PA 15642
Zip
□
Check here if above is different from previous filing
Check box to the left of employee if information is different from previous fling
(5) Resident
(1) Employee
(2) Employee
(3) Wages
(4) Tax Withheld
Municipality
Name and Address
Social Security No.
This Quarter
This Quarter
(or PSD Code)
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(6) Page Totals
Quarter # ______, 2011

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