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W2-RWEBFPM Layout 1

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W2-R Annual Reconciliation of
Earned Income Tax Withheld From Wages
As reported on Employer’s Quarterly Return (Form E-1);
with income tax withheld as shown on
Withholding Statements (W-2)
Employer Name
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)
Quarter ended March 31 .................... $
Quarter ended June 30 ...................... $
Quarter ended September 30 ............ $
Quarter ended December 31 .............. $
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.
Employer Acct No.
Federal ID No.
.
,
(A) $
EARNED INCOME TAX
Tax Paid
.
.
,
.
.
,
I DECLARE UNDER PENALITES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST
OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.
Signature_______________________________________________ Phone___________________________ Date_______________
Address
City
State
Zip
PSD Number
Municipal Location of Business
TOTAL AMOUNT OF
ENCLOSED CHECK
3. Total quarterly income tax from wages during the year as reported on Quarterly E-1 Reports
.
,
(B ) $
*W2R*
W2R
,
,
.
,
TCD Filed With
PO Box 25113
Lehigh Valley, PA 18002-5113
WEB
Due by
Last Day of February
Year:
Please see reverse for instructions
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 calling Berkheimer at 610-599-3182. Or, you can visit our website at www.hab-inc.com.
Berkheimer is not the appointed tax hearing officer for your taxing district and will not accept any petitions for appeal.
Petitions for appeal must be filed with the appropriate appeals board for your County. Berkheimer can provide you with the
proper procedures and forms necessary to file an appeal with the appeals board for your Tax Collection District.
Please complete information requested and remit to:
HAB - EMP REC
PO Box 25113
Lehigh Valley, PA 18002-5113
Filed Online
*see instructions
W2
There will be a $29.00 fee for returned payments.
There will be an additional fee assessed if no payment is enclosed for tax due at time of filing.
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INSTRUCTIONS FOR FORM W-2R
Include municipal location of business in PA, assigned account number and Federal ID number. Include employer’s full name
and address.
If no balance is due, the W2 Reconciliation can be filed online on or before the last day of February following the close of the
calendar year at: www.berk-e.com, or return the reconciliation form. If a balance is due, online filing is still available, but payment
must be submitted to the address below, along with this completed form with the “Filed Online” box checked. This form must be
accompanied by CITY INCOME TAX copy or facsimile of the Form W-2 if a file has not been submitted electronically for each
employee from whom income tax has been withheld during said year.
The total of all income tax withheld as reflected on W-2s should be entered on line 2. Total Earned Income Tax as reported on
a quarterly basis should be entered on line 3.
Payment is due, if applicable, when filing the reconciliation. Complete the reverse side of this form and mail to the address
below. Include the employee name, SSN, address, municipality and amount being paid with the reconciliation.
If an employer’s total payroll consists of a number of separate units or establishments, the Form W-2 should be assembled
accordingly and a separate reconciliation Form W-2 should be submitted.
1.
2.
3.
Remit to:
HAB - EMP REC
PO Box 25113
Lehigh Valley, PA 18002-5113
4.
5.
2018.06.29
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Completed 2 July 2020

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