Form 319 - Emplyer'S Quarterly Compensation Tax Return

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EMPLOYER NAME AND ADDRESS
BUREAU ACCOUNT NO.
TAXYEAR
QTR
FEDERAL EIN
319
YORK ADAMS TAX BUREAU
FORM
P.O. BOX 15627, YORK, PA. 17405
EMPLOYERS QUARTERLY
(717) 812-0759
COMPENSATION TAX RETURN
+ OR
-
=
$
$
1.
0.00
IF THIS TAX IS BEING
TOTAL TAX
PRIOR PERIOD ADJUSTMENT
WITHHELD DURING THIS QUARTER
REMITTED BY THE ACH
CREDIT METHOD, CHECK
PENALTY - .005 X LINE 1 FOR EACH MONTH TAX IS PAST DUE.
2.
THIS BOX.
DATE OF ACH
3.
INTEREST - .000164 X LINE 1 FOR EACH DAY TAX IS PAST DUE.
4.
TOTAL REMITTANCE. LINE 1 + LINE 2 + LINE 3
0.00
PHONE NO.
CONTACT PERSONS NAME (PRINT)
FAX NO.
AUTHORIZED OFFICERS NAME (PRINT)
EMAIL
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.
AUTHORIZED SIGNATURE REQUIRED
TITLE
DATE

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