Form Em-1 - Emergency & Municipal Services Tax

Form Em-1 - Emergency & Municipal Services Tax - 2005

EM-1 2005

EMERGENCY & MUNICIPAL

SERVICES TAX

CFD

For Employers & Self-Employed Individuals

City of Pittsburgh

Rev 12/04 FOR OFFICIAL USE ONLY

Amended Return ( )

Tax Return No Longer Needed ( )

CITY ID

FEDERAL ID

See section B, Below

TAX PERIOD

SIGNATURE______________________________________________

Due on or before

TITLE ___________________________DATE___________________

PHONE __(__________)_____________________________________

PREPARER’S NAME_______________________________________

PREPARER’S PHONE__(_________)__________________________

I hereby certify, swear and aver that all statements herein are true and correct to the best of my

knowledge and belief, being duly apprised of my duty under the law to submit honest and

complete information or be subject to the penalties provided by law.

Make name/address corrections above

MAKE SURE YOUR SIGNATURE AND DATE APPEAR ABOVE

USE BLACK INK ONLY ON THIS FORM

EMERGENCY & MUNICIPAL SERVICES TAX IS $52.00 PER EMPLOYEE, PER YEAR

1. NUMBER OF EM-2s REPORTED

This includes employees, sole proprietor and partners.

2. GROSS AMOUNT OF TAX - LINE 1 MULTIPLIED BY $52.00

You must include explanation, below, if payment is not a multiple of $52.00

3. PENALTY AND INTEREST IS 6% PER MONTH, IF APPLICABLE

Penalty per Month 5% (0.05) (Maximum 50%), Interest per Month 1% (0.01)

TOTAL PAYMENT THIS MONTH - ADD LINES 2 & 3

If no payment is due DO NOT send in this form.

Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH

Mail to: CITY TREASURER EM-1 TAX – PO BOX 642606 – PITTSBURGH PA 15264-2606

You must include explanation, below, if payment is not a multiple of $52.00

A $30.00 fee will be assessed for any check returned from the bank for any reason.

EMERGENCY & MUNICIPAL SERVICES TAX (EM-1)

SECTION B – EXPLANATION

If necessary attach additional sheets

Form Em-1 - Emergency & Municipal Services Tax - 2005