Form W-2 - Transmittal - Reconciliation

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YEAR
EMPLOYER ACCOUNT ID
ENTITY ID (EIN)
REV-1667 R AS (08-10) (I)
Part I
W-2 RECONCILIATION
DUE DATE
W-2 TRANSMITTAL
1a
Number of W-2 forms attached
JANUARY 31
1b
Number of 1099 forms with PA withholding tax
Part III
FOR MEDIA REPORTING
1c
Number of W-2s reported on magnetic tape(s)
NUMBER OF TAPES
NUMBER OF CD’s
1d
Number of W-2s reported on compact discs
2
Total compensation subject
$
▲
▲
▲
to PA withholding tax
●
BUSINESS NAME AND ADDRESS
$
3
PA INCOME TAX WITHHELD
▲
▲
▲
●
LEGAL NAME
Part II
ANNUAL RECONCILIATION
Wages paid subject to PA withholding tax
PA tax withheld
TRADE NAME
1st Quarter
2nd Quarter
ADDRESS
3rd Quarter
CITY, STATE, ZIP
4th Quarter
TOTAL
DO NOT SEND PAYMENT WITH THIS FORM.
Attach adding machine tape(s) or some acceptable listing of tax withheld
as reported on accompanying W-2 form(s) to substantiate reported PA
PRINT PAGE
RESET FORM
withholding tax.This tape or listing applies only to paper W-2s, not media
reporting.
DATE
DAYTIME TELEPHONE #
EXT.
TITLE
SIGNATURE
Please sign after printing.

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