Prepare the Annual Reconciliation of Employer Wage Tax for Philadelphia. For lines 1, 3, and 4, use gross wages and salaries per general ledger less exempt wages paid to Russell ($2,394.00) on December 14. (This amount should agree with Form W-3 Box 18, local wages.) Tax paid during the first three quarters was $5,519.60. For reporting purposes, there were 10 Philadelphia residents for whom wage tax was remitted for the pay period ending March 12, 20--. This form does not report cents, round to nearest dollar. If an input box does not require an entry, leave it blank. When required, round amounts to the nearest dollar.
⬛ ⬛
CITY OF PHILADELPHIA
ANNUAL RECONCILIATION OF
20-- EMPLOYER WAGE TAX
DUE DATE: FEBRUARY 28, 20--
Taxpayer Name and Address
GLO-BRITE PAINT COMPANY
2215 Salvador Street
Philadelphia, PA 19175-0682
City Account Number
0 0 0 1 8 5 5
Federal Identification Number
0 0 - 0 0 0 0 6 6 0
If your business terminated in 20--, enter the
termination date AND file a CHANGE FORM.
m m - d d - y y y y
YOU MUST USE THE CHANGE FORM TO REPORT A
CHANGE OF ADDRESS OR TO CANCEL THIS ACCOUNT. If this is an amended return place an "X" here:
A. Enter the number of Philadelphia Residents for whom wage tax was remitted for the pay period including
March 12, 20-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A.
B. Enter the number of nonresidents (employees living outside Philadelphia city limits) for whom wage tax was remitted for the pay period including March 12, 20-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B.
C. Total number of employees for all company locations reported on the Employer's Federal Quarterly Tax Return for the first quarter of 20-- (for the pay period including March 12, 20--) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C.
D. Number of employees working at company locations within Philadelphia city limits, for the pay period including
March 12, 20-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D.
1. Gross Compensation per W-2 forms for all employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. Non-Taxable Gross Compensation included in Line 1.
(Paid to nonresidents working outside of Philadelphia) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Gross Compensation per W-2 forms on which Philadelphia Wage Tax was withheld or due
(Line 1 minus Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Taxable Gross Compensation paid to residents of Philadelphia
in 20-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Tax Due (Line 4 times .038809) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Taxable Gross Compensation paid to nonresidents of Philadelphia
in 20-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Tax Due (Line 6 times .034567) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Total Tax Due (Add Lines 5 and 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
9. Tax previously paid for 20-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. ADDITIONAL TAX DUE If Line 8 is greater than Line 9, enter the amount here . . . . . . . . . . . . . . . . . . . . . . . . . 10.
11. TAX OVERPAID If Line 9 is greater than Line 8, enter the amount here.
See instructions for filing a Refund Petition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
Under penalties of perjury, as set forth in 18 PA C. S. §§ 4902-4903 as amended, I swear that I have reviewed this return
and accompanying statements and schedules, and to the best of my knowledge and belief, they are true and complete.
⬛ Taxpayer Signature Joseph T. O'Neill Date 2/1/- - Phone # (215) 555-9559 ⬛
Preparer Signature Date Phone #
5013 Internet 11-7-2013
Source: Philadelphia Revenue Department.