Form E2 - Employer'S Quarterly Earned Income / Emergency Municipal Services Tax Return - Berkheimer Tax Administrator

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PAGE
OF
BERKHEIMER -- TAX ADMINISTRATOR
E E 2 2
EMPLOYER'S QUARTERLY EARNED INCOME / EMERGENCY MUNICIPAL SERVICES TAX RETURN
FORM
7. Total number of EMST employees reported
1. Total EIT tax withheld from wages during quarter
E
E
EIT
EMST
8. Gross amount of tax - Line 7 X $
...........
2. Monthly EIT payments or previous quarter credits
9. Collection fee discount - Line 8 X
..........
3. Total amount of EIT taxes due this quarter
I
M
10. Net amount due (Line 8 minus Line 9) .......................
(Line 1 minus 2)
11. Penalty (
of tax) after due date ...............
4. Total pages of this return
T
S
12. Interest (
of tax per month)after due date
5. Total number of employees
13. Total Penalty and Interest due (Add Lines 11 & 12).......
6. Date period ended
14. Total Amount EMST Due - (Add Lines 10 & 13) .........
T
** SEE REVERSE SIDE FOR FURTHER INSTRUCTIONS**
15. ADD LINES
3
AND
14
FOR TOTAL AMOUNT ENCLOSED .............
Make any corrections to EMPLOYER'S NAME & ADDRESS and check here.
I DECLARE UNDER PENALTY OF LAW THAT THIS RETURN IS TO
THE BEST OF MY KNOWLEDGE A TRUE AND COMPLETE RETURN.
E2
SIGNED
TITLE
DATE
FEDERAL ID
ACCOUNT #
LOCATION
CHECK here if making any corrections or additions to EMPLOYEE'S
EMST Affidavit included
CHECK here if total amount of EMST is not submitted.
NAME/ADDRESS, SSN or RESIDENT MUNICIPALITY.
(17) EMPLOYEE'S
(18) WAGES PAID
(19) AMOUNT OF EIT TAX
(21) AMT OF EMST
(16) NAME/ADDRESS
(20) RESIDENT MUNICIPALITY
SOCIAL SECURITY NO.
THIS QUARTER
WITHHELD THIS QUARTER
WITHHELD THIS
(CITY, BOROUGH, TOWNSHIP)
QUARTER
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PAGE
PIN Number:
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ONE TOTAL
,
ONLY DETACH
IF FILING ELECTRONICALLY
Check here if filing Electronically
Make checks payable to: HAB-EIT
There will be a $20.00 fee for returned checks.
YEAR:
PIN Number:
There may be a $12.50 collection fee if payment is not enclosed
(22)
with form at the time of filing.
QUARTER:
ENTER INFORMATION FROM ABOVE
TOTAL AMOUNT OF
ACCOUNT #:
ENCLOSED CHECK
3.
(from Line 15)
9.
10.
13.
DO NOT WRITE BELOW THIS LINE
email:
e206.qxp
5/06

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