Fillable Employers Registration Form DCED CLGS32 4-8-11 (Berkheimer Tax Innovations)

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Employers Registration Form DCED CLGS32 4-8-11 (Berkheimer Tax Innovations)

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The Employers Registration Form DCED CLGS32 4-8-11 (Berkheimer Tax Innovations) form is 1 page long and contains:

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You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and collection of local taxes by contacting your Tax Officer.
EMPLOYER REGISTRATION
Local Earned Income Tax Withholding
CLGS-32-4 (8-11)
Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying
schedules and statements and to the best of my (our) belief, they are true, correct and complete.
EMPLOYER BUSINESS NAME (Use Federal ID Name)
MAIN CORPORATE/BUSINESS LOCATION - STREET ADDRESS (No PO Box, RD or RR)
SECOND LINE OF ADDRESS
CITY OR POST OFFICE STATE ZIP
EMPLOYER BUSINESS LOCATION - STREET ADDRESS WITHIN PA (if same as above, leave blank. No PO Box, RD or RR)
SECOND LINE OF ADDRESS
CITY OR POST OFFICE STATE ZIP
MUNICIPAL TAXING AUTHORITY (City, Borough or Township) IN WHICH FACILITY OR BUSINESS IS LOCATED
COUNTY BUSINESS PHONE NUMBER BUSINESS FAX NUMBER
EMPLOYER PA BUSINESS LOCATION PSD CODE FEDERAL EIN OR SOCIAL SECURITY #
EMPLOYER INFORMATION
ORGANIZATION
TYPE OF ORGANIZATION
PRIMARY NATURE/OPERATION OF BUSINESS
DATE OF INCORPORATION (MM/DD/YYYY) DATE OPERATION BEGAN AT THIS LOCATION (MM/DD/YYYY)
PRIMARY CONTACT INDIVIDUAL (First Name, Last Name)
TITLE
PRIMARY CONTACT PHONE NUMBER PRIMARY CONTACT EMAIL ADDRESS
SIGNATURE OF PRIMARY CONTACT INDIVIDUAL DATE (MM/DD/YYYY)
LLC Individual Proprietorship Partnership Association Fiduciary Corporation
ACCOUNTING INFORMATION
Does your organization have multiple site locations within Pennsylvania? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Has your organization opted to remit EIT for employees at all locations to a single Tax Collection District? . . . . . . . . . . . Yes No
If YES, please insert 2-digit code for Tax Collection District Selected (choose from list on reverse side) . . . . . . . . . . . . . .
01 ADAMS TAX COLLECTION DISTRICT
70 ALLEGHENY CENTRAL TAX COLLECTION DISTRICT
71 ALLEGHENY NORTH TAX COLLECTION DISTRICT
72 ALLEGHENY SOUTHEAST TAX COLLECTION DISTRICT
73 ALLEGHENY SOUTHWEST TAX COLLECTION DISTRICT
03 ARMSTRONG TAX COLLECTION DISTRICT
04 BEAVER TAX COLLECTION DISTRICT
05 BEDFORD TAX COLLECTION DISTRICT
06 BERKS TAX COLLECTION DISTRICT
07 BLAIR TAX COLLECTION DISTRICT
08 BRADFORD TAX COLLECTION DISTRICT
09 BUCKS TAX COLLECTION DISTRICT
10 BUTLER TAX COLLECTION DISTRICT
11 CAMBRIA TAX COLLECTION DISTRICT
12 CAMERON TAX COLLECTION DISTRICT
13 CARBON TAX COLLECTION DISTRICT
14 CENTRE TAX COLLECTION DISTRICT
15 CHESTER TAX COLLECTION DISTRICT
16 CLARION TAX COLLECTION DISTRICT
17 CLEARFIELD TAX COLLECTION DISTRICT
18 CLINTON TAX COLLECTIO DISTRICT
19 COLUMBIA TAX COLLECTION DISTRICT
20 CRAWFORD TAX COLLECTION DISTRICT
21 CUMBERLAND TAX COLLECTION DISTRICT
22 DAUPHIN TAX COLLECTION DISTRICT
23 DELAWARE TAX COLLECTION DISTRICT
24 ELK TAX COLLECTION DISTRICT
25 ERIE TAX COLLECTION DISTRICT
26 FAYETTE TAX COLLECTION DISTRICT
27 FOREST TAX COLLECTION DISTRICT
28 FRANKLIN TAX COLLECTION DISTRICT
29 FULTON TAX COLLECTION DISTRICT
30 GREENE TAX COLLECTION DISTRICT
31 HUNTINGDON TAX COLLECTION DISTRICT
TCD Code Tax Collection District
32 INDIANA TAX COLLECTION DISTRICT
33 JEFFERSON TAX COLLECTION DISTRICT
34 JUNIATA TAX COLLECTION DISTRICT
35 LACKAWANNA TAX COLLECTION DISTRICT
36 LANCASTER TAX COLLECTION DISTRICT
37 LAWRENCE TAX COLLECTION DISTRICT
38 LEBANON TAX COLLECTION DISTRICT
39 LEHIGH TAX COLLECTION DISTRICT
40 LUZERNE TAX COLLECTION DISTRICT
41 LYCOMING TAX COLLECTION DISTRICT
42 MCKEAN TAX COLLECTION DISTRICT
43 MERCER TAX COLLECTION DISTRICT
44 MIFFLIN TAX COLLECTION DISTRICT
45 MONROE TAX COLLECTION DISTRICT
46 MONTGOMERY TAX COLLECTION DISTRICT
47 MONTOUR TAX COLLECTION DISTRICT
48 NORTHAMPTON TAX COLLECTION DISTRICT
49 NORTHUMBERLAND TAX COLLECTION DISTRICT
50 PERRY TAX COLLECTION DISTRICT
51 PHILADELPHIA TAX COLLECTION DISTRICT
52 PIKE TAX COLLECTION DISTRICT
53 POTTER TAX COLLECTION DISTRICT
54 SCHUYLKILL TAX COLLECTION DISTRICT
55 SNYDER TAX COLLECTION DISTRICT
56 SOMERSET TAX COLLECTION DISTRICT
57 SULLIVAN TAX COLLECTION DISTRICT
58 SUSQUEHANNA TAX COLLECTION DISTRICT
59 TIOGA TAX COLLECTION DISTRICT
60 UNION TAX COLLECTION DISTRICT
61 VENANGO TAX COLLECTION DISTRICT
62 WARREN TAX COLLECTION DISTRICT
63 WASHINGTON TAX COLLECTION DISTRICT
64 WAYNE TAX COLLECTION DISTRICT
65 WESTMORELAND TAX COLLECTION DISTRICT
66 WYOMING TAX COLLECTION DISTRICT
67 YORK TAX COLLECTION DISTRICT
TCD Code Tax Collection District
CLGS-32-4 (8-11)
Tax Collection Districts
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Employers Registration Form DCED CLGS32 4-8-11 (Berkheimer Tax Innovations)

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Completed 16 July 2020

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