As reported on Employer’s Quarterly Return, with income tax withheld as shown on Withholding Statements (W-2)
Due by the Last Day of February
Year
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.
W2-R ANNUAL RECONCILIATION
Earned Income Tax Withheld from Wages
CLGS-32-2 (10-19)
EMPLOYER BUSINESS NAME (UseFederal ID Name)
EMPLOYER BUSINESS STREET ADDRESS (No PO Box, RD or RR)
SECOND LINE OF ADDRESS
CITY OR POST OFFICE STATE ZIP CODE
MUNICIPAL LOCATION OF BUSINESS
EMPLOYER PSD CODE EMPLOYER ACCOUNT NUMBER FEDERAL ID NUMBER
1. Total number of withholding statements (W-2s) accompanying this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Total income tax withheld from all wages during the year as shown on (W-2s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
EARNED INCOME TAX Tax Paid
Quarter ended March 31 $
Quarter ended June 30 $
Quarter ended September 30 $
Quarter ended December 31 $
3. $
TOTAL - difference between (A) and (B) above
$
TOTAL AMOUNT OF ENCLOSED PAYMENT
$
4. Any difference between A and B must be explained in attached statement. Where A and B do not agree, please remit or request refund.
Instructions for W2-R Annual Reconciliation Form
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.
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)
■
■
■
Keystone Collections
Group
POBox 559
Irwin, PA 15642-0559
■
(A)
Total quarterly income tax from wages during the year as reported on Quarterly Returns . . . . . . . . . . . . . . . . . . .
(
. . .
B
.
)
USE ONLY BLACK OR BLUE INK TO COMPLETE THIS FORM. USE ORIGINAL FORM - DO NOT PHOTOCOPY.
FILE ONLINE AT https://Business.KeystoneCollects.com
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Make check payable to Keystone Collections Group
File ONLINE at https://Business.KeystoneCollects.com
In the “Workplace Location" box above, include the name of the Pennsylvania municipal taxing jurisdiction in which the workplace
facility is located. In the appropriate boxes, include: the PSD Code associated with the municipal location of the workplace facility, assigned
account number and Federal ID number. In the address field, include or correct employer’s full business name and mailing address.
On or before the last day of February following the close of the calendar year, file your reconciliation with the Tax Officer, accompanied
by each employee’s form W-2 (CITY INCOME TAX copy).
On Line 2, enter the total income tax withheld from all wages during the year as shown on W-2(s). On Line 3, enter the total
quarterly income tax from wages as reported on quarterly returns.
Remit any balance due when filing the reconciliation. Attach statement of explanation showing a breakdown of the specific detail for each
employee withholding adjustment. With each adjustment, include the employee’s name, SSN, resident street address (no PO
Boxes), resident PSD Code and amount remitted with reconciliation.
1.
2.
3.
4.
File ONLINE at https://Business.KeystoneCollects.com
