Employer'S Reconciliation Of Earned Income Tax And Ls Tax For Tax Year

Employer'S Reconciliation Of Earned Income Tax And Ls Tax For Tax Year - 2011

WEST SHORE TAX BUREAU

3607 ROSEMONT AVENUE PO BOX 656 CAMP HILL PA 17001-0656

2011

EMPLOYER'S RECONCILIATION OF EARNED INCOME TAX AND LS TAX FOR TAX YEAR 2011

EMPLOYER'S

RECONCILIATION

EMPLOYER NAME AND NUMBER __________________________________________________________________

This form must be returned even

EIN _______________________________________

though no tax was withheld during

the year. This form must be filed

1. ENTER NUMBER OF W-2 STATEMENTS SENT WITH THIS RETURN

on or before February 28, 2012

2. EMPLOYERS WITH MORE THAN (5) EMPLOYEES, ENTER TOTAL OF

and must be accompanied by

LOCAL EARNED INCOME TAX WITHHELD SHOWN ON W-2'S AND ENCLOSE

a W-2 form or a magnetic media

record for every employee from whom

A LISTING OF THE INDIVIDUAL TAX AMOUNTS MAKING UP THE TOTAL

earned income tax was withheld

during the year.

EARNED INCOME TAX

LS TAX

COMPENSATION

TAX

QUARTER ENDING

TAX PAID

REPORTED

MARCH 31

JUNE 30

SEPTEMBER 30

DECEMBER 31

TOTALS

I DECLARE UNDER PENALTIES PROVIDED BY LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST

OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.

Signature: _______________________________________

Phone: (____)____________________ Date: _______________________

WESTAB FORM W-2 REC FORM (REV. 3-11)

Employer'S Reconciliation Of Earned Income Tax And Ls Tax For Tax Year - 2011