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                 CITY OF PHILADELPHIA                                                                                                               City Account Number
         ANNUAL RECONCILIATION OF 2018                                   1      8 1    8
                 EMPLOYER WAGE TAX
         DUE DATE:  FEBRUARY 28, 2019                                                                                                  Federal Identification Number
   Taxpayer Name and Address

                                                                                                                                                    To file online, go to
                                                                                                                                       https://ework.phila.gov/revenue

DO NOT REPORT NEGATIVE NUMBERS ON THIS RETURN
If your business terminated in 2018, enter the termination date   AND    file a CHANGE FORM.                                                        -m m -d d            y y y yYOU 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, 2018................................................................................................................................................... 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, 2018................................................................................. B.
C.  Total number of employees   for all company locations reported on the Employer's Federal Quarterly
     Tax Return for the first quarter of 2018 (for the pay period including March 12, 2018)...................................... C.
D.  Number of employees working   at company locations within Philadelphia city limits, for the pay period
     including March 12, 2018.................................................................................................................................... D.

  1.  Gross Compensation per W-2 forms for all employees................................................                            1.                                          .00
  2.  Non-Taxable Gross Compensation included in Line 1.
       (Paid to nonresidents working outside of Philadelphia)................................................                       2.                                          .00
  3.  Taxable income paid to employees earning tips on which City Wage Tax
       was not withheld............................................................................................................ 3.                                          .00
  4.  Gross Compensation per W-2 forms on which Philadelphia Wage Tax was
       withheld or due (Line 1 minus [Line 2 plus Line 3])......................................................                    4.                                          .00
  5.    Taxable Gross Compensation paid to   residents of Philadelphia
         January 1, 2018 to June 30, 2018..............................................................................             5.                                          .00

  6.  Tax Due (Line 5 times .038907)....................................................................................            6.                                          .00
  7.    Taxable Gross Compensation paid to   residents of Philadelphia
         July 1, 2018 to December 31, 2018 ............................................................................             7.                                          .00

  8.  Tax Due (Line 7 times .038809)....................................................................................            8.                                          .00
  9.    Taxable Gross Compensation paid to   nonresidents of Philadelphia
         January 1, 2018 to June 30, 2018...............................................................................            9.                                          .00
10.  Tax Due (Line 9 times .034654).................................................................................... 10.                                                     .00
11.    Taxable Gross Compensation paid to   nonresidents of Philadelphia
       July 1, 2018 to December 31, 2018............................................................................. 11.                                                       .00

12.  Tax Due (Line 11 times .034567).................................................................................. 12.                                                      .00

13.    Total Tax Due   (Add Lines 6, 8, 10 and 12).................................................................. 13.                                                        .00

14.    Tax previously paid for 2018...................................................................................... 14.                                                   .00

15.    ADDITIONAL TAX DUE  If Line 13 is greater than Line 14, enter the amount here................15.                                                                         .00
16.    TAX OVERPAID  If Line 14 is greater than Line 13, enter the amount here.
       See instructions.........................................................................................................................16.                             .00

         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________________________________________  Date_______________________Phone #_________________________

         Preparer Signature_________________________________________ Date_______________________Phone #_________________________
                                                                                                                                                    2018 Wage 10-2-2018






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