Business Privilege And Mercantile Tax Return - City Of Bethlehem - 2016
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1READ INSTRUCTIONS ON THE BACK BEFORE COMPLETING FORM
2016
OFFICIAL USE ONLY
CITY OF BETHLEHEM &
BETHLEHEM AREA SCHOOL
DISTRICT
BUSINESS PRIVILEGE AND MERCANTILE TAX RETURN
DATE REC'D
AMT REC'D
FINAL RETURN FOR CALENDAR YEAR ENDED DECEMBER 31, 2016
VOLUME OF BUSINESS: JANUARY 1, 2016 THROUGH DECEMBER 31, 2016
LICENSE FEE PERIOD: MAY 1, 2017 THROUGH APRIL 30, 2018
CHECK NO
BATCH NO
Due Date May 1, 2017
BUSINESS ACCOUNT
NUMBER:
EIN/SSN:
BUSINESS LOCATION:
DID YOU TERMINATE / MOVE THIS BUSINESS
IF MOVED, WHERE?
□ YES
□ NO □ MOVED
DATE:
□
NON-PROFIT □ MANUFACTURER
NO
ENTER WHOLE DOLLAR AMOUNTS ONLY
DOLLARS
CENTS
A return must be filed even if you have no gross receipts
00
1. Sales or Gross Receipts (January 2016 to December 2016 only)
1.
00
2. Exclusions (Must attach written proof)
2.
00
3. Taxable Gross Receipts (Line 1 Less Line 2)
3.
FINAL RETURN FOR YEAR ENDED DECEMBER 31, 2016
RECEIPTS FROM LINE ABOVE
TAX COMPUTATIONS
x .001
00
4.
4.
4. Wholesale
x .0015
00
5.
5.
5. Retail
x .0015
00
6.
6.
6.Service
x .0015
00
7. Rental / Other Income
7.
7.
8. Total (add Lines 4, 5, 6, & 7)
00
8.
8.
9. Deduct amount already paid on Musikfest, Celticfest, Christkindlmarket,
00
9.
or other special events (see back of form)
00
10.
10. Total Tax Due, or Credit (Line 8 Less Line 9)
ESTIMATED TAX RETURN FOR YEAR ENDING DECEMBER 31, 2017
N/A
00
11.
11. Estimated Tax
TOTAL TAX DUE IF PAID BY MAY 1, 2017
00
12. Add Line 10 and Line 11
12.
PENALTY AND INTEREST IF TAX PAID AFTER MAY 1, 2017
00
13. Add: 10% Penalty if paid after May 1, 2017 (multiply Line 12 x 10%)
13.
00
14. Add: 1% Penalty per month or part thereof (multiply Line 12 x 1% x No. of months)
14.
00
15. TOTAL TAX, PENALTY AND INTEREST (Add Lines 12,13, & 14)
15.
LICENSE FEE
16. 2016 Annual License Fee or Non-Profit Admin Fee
(separate License for each location, $25 per location)
25 x ___ =
00
16.
(Exemption for HIC License, provide HIC #________________ and Expiration Date ___________)
00
17. Total Amount Due (Add Lines 15 & 16)
17.
Any Work Papers containing calculations used to determine Gross Receipts and copies of Federal Returns shall be attached to this return.
Tax return will not be considered complete unless such documents are attached.
Make Check Payable to:
CITY OF BETHLEHEM
Mail Return and Payment to: TRI-STATE FINANCIAL GROUP
-
PO BOX 38
SEND ORIGINAL WITH PAYMENT
MAKE A COPY FOR YOUR RECORDS
BRIDGEPORT, PA 19405
I declare under penalty of law that all statements made here and/or in supporting
610-270-9520
schedules are true, correct and complete to the best of my knowledge and belief.
Print Name
Telephone Number
“As required by Pennsylvania law, Bethlehem City will provide upon
request a disclosure statement explaining to the taxpayer their rights in
certain tax proceedings involving the City.”
Signature
Date
FORM MUST BE PREPARED IN ITS ENTIRETY, SIGNED AND DATED. IF
Signature of Person Preparing Return (if other than taxpayer)
Date
NOT THE FORM WILL BE RETURNED AND PENALTY AND INTEREST
ADDED UNTIL COMPLETED FORM IS RECEIVED.
Address of Preparer
Telephone Number
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