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City of Philadelphia Department of Revenue
Design Specifications, Samples and Instructions for
2018 Tax Returns, Schedules and Payment Coupons

Certain guidelines must be followed for reproduced or substitute City of Philadelphia Department of Revenue tax
returns. The purpose of these guidelines is to ensure that the reproduced or substitute forms are compatible with
the Department's processing system, and that they present information in a uniform manner.

The following are guidelines for substitute and reproduced tax forms and schedules. Following these
guidelines will help speed the approval process and processing of taxpayer forms. It is recommended
that submission be made using .pdf files as e-mail attachments.

Schedules retained by the taxpayer, instructions and the Change Form are included for your convenience but are
not required to be submitted for approval.

All questions or comments concerning the design specifications of these forms should be directed to Tristan
Pounds (tristan.pounds@phila.gov) and Darius Thomas (Darius.Thomas@phila.gov): For information regarding
tax regulations, visit our web site at www.phila.gov/revenue. For general information call Taxpayer Services
at 215-686-6600.

The vendor's name must appear at the bottom of each page. The preferred location on page 1 of each
document is in the lower left-hand corner.

Submit one sample of each form requiring approval and which must have a full field entry on every line.
Blank samples are not required.

Submit sample tax returns for approval via e-mail as .pdf files or mail to:
Darius Thomas & Tristan Pounds
City of Philadelphia Department of Revenue
Municipal Services Building Room 330
1401 John F. Kennedy Boulevard
Philadelphia, PA 19102

Each page is measured 85 characters across (X), 66 characters down (Y).

Each page has a registration mark in each of the four corners. The marks measure 3/16 of an inch
square.

Printing Forms: Software must inform taxpayer to send the originally printed form, not a photocopy, for
processing. Printed forms from software should require the taxpayer to select the following printing choices before
the printing option can be chosen. “Shrink to fit” and “Reduce to printer margins” must be unchecked. “No
graphics” must be unchecked.

Page Size: Reproduced or substitute forms must be printed on 8 1/2" x 11" paper.

Font Size: The preferred font and size to use for all entries of variable data is Courier 12 pt.

Form Numbers: Form numbers shall be printed using 3 of 9 barcode (Code 39).

Two-Sided Forms: Reproduced or substitute forms may be printed on one side or both sides of the paper.

Rounding and Number formatting: All amounts should be numeric only and right justified. If the field is zero,
leave blank. All amounts filled in on these forms should be rounded to the nearest dollar (drop amounts under
50¢ and increase amounts that are 50¢ or more to the next dollar). In dollar amount entries do not include a
dollar symbol, a cent symbol or any commas. Do not use parentheses, brackets, the minus sign or the word
“loss” for negative numbers. Where appropriate, lines indicating a negative number will have an “X” placed at
the beginning of that line. Do print “.00” (or cents) on any dollar amount lines.

Changes to 2018 Forms

The BIR and BIR-EZ returns include a new Schedule SC used to calculate Special Credits.

Rate changes have been made to 2018 Tax Return forms.

A secondary Barcode has been added to the Bottom Right of each return to assist with Form Processing.

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                     Important Information for Filing Business Income and Receipts Tax 
 
 If all business is conducted and/or located within Philadelphia, only the BIRT-EZ Pages 1 and 2 should be 
 completed, printed and filed. 
 
 If business  is conducted and/or  located both  in and out  of Philadelphia, the           BIRT  Page  1 and the 
 appropriate  combination  of  Schedules  A  through  E       should  be  completed,  printed  and  filed.  Tax 
 practitioners should be able to print Page 1 and all completed schedules without restrictions. 
 
 Taxpayers must use the same method (Schedule A, Method I or Schedule B, Method II) that they elected 
 on the first Business Income & Receipts Tax return filed. Only Schedule A (Form 24715) or Schedule B 
 (Form 24415) should be completed, printed and filed. 
 
 Schedule C-1 – Computation of apportionment factors to be applied to apportionable net income. You 
 must complete Schedule C-1 if you are apportioning your income. Failure to include this schedule with 
 the return may result in the disallowance of your apportionment and you may be billed. Schedule C 
 should not be completed or filed if the BIRT-EZ return is used. 
 
 If Line 12 of Schedule C-1 of the Business Income and Receipts Tax Regular return is equal to 100%, the 
 BIRT-EZ return must be used instead. Schedule C-1 should not be completed or filed if the BIRT-EZ 
 return is used. 
 
                                                 Payment of Tax Due 
 
 Payment of tax due should be made using payment coupons.           Taxpayers must include a coupon for proper 
 credit and       timely processing.       Payment      coupons       can   be    printed   on-line by     going    to 
 https://ework.phila.gov/revenue. 
 
 Payment of tax due can be made by credit card or e-check at www.phila.gov/revenue. A user fee of 2.45% 
 is added when paying by credit card, and $5.95 when paying by debit card. E-CHECK IS FREE. 
 
 ACH Debits and Credits are accepted for payment of Business Income and Receipts Tax. For more 
 information or to enroll in this program go to www.phila.gov/revenue and click “Payments & E-File” then 
 select “Pay Taxes”. Contact the Electronic Government Unit at 215-686-6582, 6628 or 6459 or e-mail 
 egovservices@phila.gov. 
 
 Returned Checks.    If your check is returned unpaid for insufficient or uncollected funds, (1)  you authorize 
 The City of Philadelphia or its agent to make a one-time electronic funds transfer from your account to collect 
 a  fee  of  $20;  and  (2) The City of Philadelphia or its agent may re-present your check electronically to your 
 depository institution for payment. 
 
 The scan line is 68 characters in length, the 68 characterth being a check digit using the mod 10 routine and must 
 be printed in 12 pt. OCR-A font. The bottom edge of the scan line must print 1” from the bottom of the coupon 
 and 3/8” from the right edge of the coupon (start position X=14, Y=60). Examples of coupons for each tax type 
 are provided in this package. 

 Sample coupons must be submitted to verify placement of variable data and validity of the scan line check digit. 

 Taxpayers and practitioners seeking a technical tax consultation with the Technical Staff must submit their 
 questions via e-mail to revenuetaxadvisors@phila.gov. Inquiries regarding tax notices, tax bills, and tax account 
 information maintenance/changes should be made to the Taxpayer Services Area of the Department. Taxpayer 
 Services phone number is 215.686.6600. Their e-mail address is       revenue@phila.gov. Basic tax questions (e.g. 
 an explanation of or the calculation of Business Privilege Tax taxable gross receipts and apportioned/taxable net 
 income, taxable Net Profits, taxable Philadelphia Wages, filing Wage and Business Tax Refund petitions, etc.) 
 can  be  e-mailed  to  the  Audit  Division  at revenueaudit@phila.gov.  The  Audit  Division  telephone  number  is 
 215.686.6500.  Please research the Department’s website at         www.phila.gov/revenue   and the Technical Rulings 
 / Tax Regulations link before e-mailing your question. 
 
                                           Revised October 29, 2018

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Scan Line Specifications for Vendor Reproduced Payment Coupons

Certain guidelines must be followed for reproduced or substitute City of Philadelphia Department of
Revenue tax coupons. The purpose of these guidelines is to ensure that the reproduced or substitute
forms are compatible with the Department's processing system, and that they present information in a
uniform manner.

As part of the Revenue Department’s modernization project, the department is adding 2-D barcodes
to our payment coupons. The barcodes will allow for faster and more accurate processing of
payments. Effective with the 2018 tax year payments, all coupons must contain a 2-D barcode and a
68-character scanline.

The following are guidelines for substitute and reproduced tax payment coupons. Following
these guidelines will help speed the approval process and processing of taxpayer payments. It
is recommended that submission be made using .pdf files as e-mail attachments.

Each page is measured 85 characters across (X), 66 characters down (Y) using the NACTP 10 x 6
grid.

Each coupon must have registration targets in each of the four corners. The marks measure 3/16 of
an inch square. The marks should be placed ¼ inch from the top and sides and ½ inch from the
bottom of each printed coupon.

The scan lines of reproduced payment coupons will be a 2-D barcode in PDF417 format. The scan
line is 68 characters in length, the 68th character being a check digit using the mod 10 routine.
Stretching or scaling the barcode changes its integrity and reduces the readability of the barcode; it
should not be done.

If a software developer does not support 2-D barcodes, the area reserved for the barcode should be
left blank and the scan line must be printed in 12 pt. OCR-A font. The bottom edge of the scan line
must print 1” from the bottom of the coupon and 3/8” from the right edge of the coupon (start position
X=14, Y=60). The scan line layout and examples of coupons for each tax type are provided in this
package.

Sample coupons must be submitted to verify placement of variable data and validity of the scan line
check digit and/or barcode.

Revenue for Schools and Services

Revised 11-5-2018

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2D Barcode Details

1. Required Type of 2D Barcode:
a. PDF417.
2. Encoded contents of 2D Barcode:
a. 3‐ digit form ID (unique to each coupon type) concatenated with the payment coupon
scanline. Form ID’s are listed below.
3. Position of 2D Barcode:
a. Upper left corner should begin at 0.9 inches from the left of the coupon, and 8.85 inches
from the top of the coupon.

Tax Type Abbreviation Form ID
Earnings ERN 201
Business Income and Receipts Tax BIR 202
Net Profits Tax NPT 203
Wage Tax WAG 204
Amusement AMU 205
Parking PRK 206
Valet Parking Tax VPT 207
Vehicle Rental Tax VRT 208
Outdoor Advertising Tax OAT 209
School Income Tax SIT 210
Hotel HOT 211
Liquor LIQ 212
Current Real Estate Tax REA 213
Delinquent Real Estate Tax REA 214

Revised 12-24-2018

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                               Check Digit Calculation 

The scan-line is 68 positions, all numeric, with the Check-Digit in position 68. To calculate the 
Check-Digit, do the following: 

 1.  For each position 1 through 67, assign a numeric value to the position based on the 
    contents of the position and whether the position itself is even or odd. 
 2.  Add the assigned value for each position into a total. 
 3.  Compute the Check-Digit as 700 minus the final total. 

Assigning the numeric value to even positions 

 1.  For even positions 2, 4, 6, …, 66 accept the value of the position as the assigned 
    numeric value. 
    a.  For a value of 0, the assigned numeric value is 0 
    b.  For a value of 1, the assigned numeric value is 1 
    c.  For a value of 2, the assigned numeric value is 2  
    d.  For a value of 3, the assigned numeric value is 3 
    e.  For a value of 4, the assigned numeric value is 4 
    f.  For a value of 5, the assigned numeric value is 5 
    g.  For a value of 6, the assigned numeric value is 6 
    h.  For a value of 7, the assigned numeric value is 7 
    i.  For a value of 8, the assigned numeric value is 8 
    j.  For a value of 9, the assigned numeric value is 9 
     
Assigning the numeric value to odd positions 

 1.  For odd positions 1, 3, 5, …, 67 compute the assigned numeric value as follows: 
    a.  Multiply the value of the position by 2 
    b.  Where the resulting value is greater than 9, add 1 to the unit value. 
     i.  For a value of 0;  0 * 2 = 0. The assigned numeric value is 0. 
     ii.  For a value of 1;  1 * 2 = 2. The assigned numeric value is 2. 
     iii.  For a value of 2;  2 * 2 = 4. The assigned numeric value is 4. 
     iv.  For a value of 3;  3 * 2 = 6. The assigned numeric value is 6. 
     v.  For a value of 4;  4 * 2 = 8. The assigned numeric value is 8. 
     vi.  For a value of 5;  5 * 2 = 10. The assigned numeric value is 1 + 0 = 1. 
     vii.  For a value of 6;  6 * 2 = 12. The assigned numeric value is 1 + 2 = 3. 
     viii.  For a value of 7;  7 * 2 = 14. The assigned numeric value is 1 + 4 = 5. 
     ix.  For a value of 8;  8 * 2 = 16. The assigned numeric value is 1 + 6 = 7. 
     x.  For a value of 9;  9 * 2 = 18. The assigned numeric value is 1 + 8 = 9. 

FYI 

Based on the logic of subprogram RTTAN142, which performs the Check-Digit calculation

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             2018 Business Income and Receipts Tax - EZ Page 1 
     
                                        Form Barcode Number: 0418 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Variable Field                              # of chars.        X/Y Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/60 
    Bottom Right Reg. Mark                                         79/60 
                                                                   
    Name & Address Line 1                       40                 7/10 to 46/10 
    Name & Address Line 2                       40                 7/11 to 46/11 
    Name & Address Line 3                       40                 7/12 to 46/12 
    Name & Address Line 4                       40                 7/13 to 46/13 
    Name & Address Line 5                       40                 7/14 to 46/14 
    E-mail Address                              30                 50/15 to 79/15 
    Change of Address Box                       1                  44/16 to 44/16 
                                                                   
    City Account Number                         7                  62/8 to 68/8 
    Federal Identification Number               9                  61/10 to 69/10 
    Social Security Number                      9                  61/12 to 69/12 
                                                                   
    Termination Date                            10                 60/18 to 69/18 
    Amended Return Check Box                    1                  79/20 to 79/20 
                                                                   
    Line 1                                      7                  68/23 to 74/23 
    Line 2                                      7                  68/25 to 74/25 
    Line 3                                      7                  68/27 to 74/27 
    Line 4                                      7                  68/29 to 74/29 
    Line 5                                      7                  68/31 to 74/31 
    Line 6a                                     7                  68/34 to 74/34 
    Line 6b                                     7                  68/36 to 74/36 
    Line 6c                                     7                  68/38 to 74/38 
    Line 7                                      7                  68/40 to 74/40 
    Line 8                                      7                  68/42 to 74/42 
    Line 9                                      7                  68/44 to 74/44 
    Line 10a                                    7                  68/47 to 74/47 
    Line 10b                                    7                  68/49 to 74/49 
    Line 10c                                    7                  68/51 to 74/51

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                                        2018 BIRT – EZ Page 2 
   
                                        Form Barcode Number: 0518 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/63 
    Bottom Right Reg. Mark                                         79/63 
                                                                   
    City Account Number                         7                  62/5 to 68/5 
                                                                   
    Line 1 Check Box                            1                  61/11 to 61/11 
    Line 1                                      9                  67/11 to 75/11 
    Line 2 Check Box                            1                  61/13 to 61/13 
    Line 2                                      9                  67/13 to 75/13 
    Line 3                                      9                  67/15 to 75/15 
    Line 4                                      9                  67/17 to 75/17 
    Line 5 Check Box                            1                  61/19 to 61/19 
    Line 5                                      9                  67/19 to 75/19 
    Line 6                                      9                  67/21 to 75/21 
                                                                   
    Line 7a                                     11                 65/26 to 75/26 
    Line 7b                                     11                 65/28 to 75/28 
    Line 7c                                     11                 65/30 to 75/30 
    Line 7d                                     11                 65/32 to 75/32 
    Line 7e                                     11                 65/34 to 75/34 
    Line 7f                                     11                 65/36 to 75/36 
    Line 7g                                     11                 65/38 to 75/38 
    Line 7h                                     11                 65/40 to 75/40 
    Line 7i                                     11                 65/42 to 75/42 
    Line 8                                      11                 65/44 to 75/44 
    Line 9                                      11                 65/46 to 75/46 
    Line 10                                     11                 65/48 to 75/48 
    Line 11                                     11                 65/50 to 75/50 

                                             Worksheet S 
   
    Line S1                                     11                 65/53 to 75/53 
    Line S2                                     11                 65/55 to 75/55 
    Line S3                                     11                 65/57 to 75/57 
    Line S4                                     6                  70/59 to 75/59 
    Line S5                                     11                 65/61 to 75/61

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CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE 2018 BIRT-EZ
2018 BUSINESS INCOME & RECEIPTS TAX
For business conducted 100% in Philadelphia City Account Number
DUE DATE: APRIL 15, 2019
7777777

Name and address..................Line 1 EIN 999999999
Name and address..................Line 2
Name and address..................Line 3 SSN 999999999
Name and address..................Line 4
Name and address..................Line 5 Taxpayer E-mail Address
aaaaaaaaaaaaaaaaaaaaaaaaaa.ddd
If this is a change of address, file a Change Form and check this box: X

If your business terminated in 2018, enter the termination date AND file a CHANGE FORM. mm-dd-yyyy

YOU MUST COMPLETE WORKSHEET "S-EZ" If this is an amended return place an "X" here: X
COMPUTATION OF TAX DUE OR OVERPAYMENT
1. NET INCOME PORTION OF TAX (from Page 2, Line 6).
If there is no tax due, enter "0"...................................................................................................... 1. 9999999
2. GROSS RECEIPTS PORTION OF TAX (from Page 2, Line 11).
If there is no tax due, enter "0"...................................................................................................... 2. 9999999

3. Tax Due for the 2018 Business Income & Receipts Tax (Line 1 plus Line 2).............................. 3. 9999999

4. MANDATORY 2019 BIRT Estimated Payment (See Instructions) .......................................... 4. 9999999

5. Total Due by 4/15/2019 (Line 3 plus Line 4)................................................................................ 5. 9999999
ESTIMATED PAYMENTS AND OTHER CREDITS
6a. Include any estimated and/or extension payments of 2018 BIRT previously made
and any credit from overpayment of the 2017 BIRT and/or 2018 NPT return...................... 6a. 9999999

6b. Credit from Special Credit Schedule (SC). (Cannot exceed amount on Line 3)........................ 6b. 9999999

6c. Total payments and credits. (Line 6a plus Line 6b).................................................................... 6c. 9999999
7. Net Tax Due (Line 5 less Line 6c).
If Line 6c is greater than Line 5, enter "0"...................................................................................... 7. 9999999
8. Interest and Penalty
Refer to web site for current percentage........................................................................................ 8. 9999999
9. TOTAL DUE including Interest and Penalty (Line 7 plus Line 8).
Use payment coupon. Make check payable to: "City of Philadelphia"................................. 9. 9999999
OVERPAYMENT OPTIONS If Line 6C is greater than Line 5, enter the amount to be:
10a. Refunded. Do not file a separate Refund Petition........................................................... 10a. 9999999

10b. Applied to the 2018 Net Profits Tax Return................................................................................ 10b. 9999999

10c. Applied to the 2019 Business Income & Receipts Tax............................................................... 10c. 9999999

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 BIRT-EZ P1 Vendor 9-28-2018
Page 1

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                       2018 BIRT-EZ                                                                                                                  City Account Number
       TAX COMPUTATION SCHEDULES                                                                                                                      7777777

If business is operated inside and outside of Philadelphia, you   must file the BIRT Regular return available at   www.phila.gov/revenue.
Reminder -   You   must use the same method (METHOD I or METHOD II) that you elected on the first Business Income & Receipts Tax return filed.
NET INCOME PORTION                                      Place "X" in box to indicate a loss.
                                                                                                                                                     
1.    METHOD II.  Net Income (or loss) as properly reported to the Federal Government....................... 1.                                       X 999999999
                                           OR
2.    METHOD I.  Net Income (or loss) in accordance with Accounting System....................................... 2.                                  X 999999999

3.  Statutory Net Income Deduction from Worksheet S-EZ, Line S5, below................................... 3.                                            999999999

4.  Loss Carry Forward, if any................................................................................................................. 4.      999999999

5.  Taxable Income or loss.  (Amount on Line 1 OR Line 2 minus Line 3 minus Line 4)....................... 5.                                         X 999999999

6.    TAX DUE (Line 5 X .0630).   If Line 5 is a loss, enter zero here and on Page 1, Line 1................ 6.                                         999999999

GROSS RECEIPTS PORTION
                                                        Do not report negative numbers for gross receipts.
TAXABLE GROSS RECEIPTS from:
   7a.  Sales and/or rentals of tangible personal property..................................................................7a.                         99999999999

7b.  Services...................................................................................................................................7b.     99999999999

7c.  Rentals of real property........................................................................................................... 7c.            99999999999

7d.  Royalties.................................................................................................................................. 7d.    99999999999

7e.  Gains on sales of capital business assets..............................................................................             7e.            99999999999

7f.  Gains on sales of stocks, bonds, etc.  (Not applicable to individuals.).....................................                        7f.            99999999999

7g.  Dividends.  (Not applicable to individuals.).............................................................................. 7g.                     99999999999

7h.  Interest.  (Not applicable to individuals.)..................................................................................       7h.            99999999999

7 i.  Other.  (Describe) ____________________________________________............................                                                7i.    99999999999

8.  TAXABLE GROSS RECEIPTS before Statutory Exclusion.  (Add Lines 7a through 7i.).........8.                                                           99999999999

9.  Statutory Exclusion (Lower of Line 8 or $100,000.00).........................................................9.                                     99999999999

10.  Net taxable Gross Receipts (Line 8 minus Line 9)..................................................................10.                              99999999999

11.    TAX DUE.    (Line 10 X .001415).    Enter here and on Page 1, Line 2....................................11.                                      99999999999
Worksheet S-EZ - Use to calculate Statutory Net Income Deduction
S1.  Enter the lower of Line 8 above or $100,000.00............................................................                          S1.            99999999999

S2.  Enter Net Income from Line 1 or Line 2.  If loss, enter zero..........................................                              S2.            99999999999

S3.  Enter Taxable Gross Receipts from Line 8 above.........................................................                             S3.            99999999999

S4.  Divide Line S2 by Line S3.  (Cannot be greater than 1.0000)........................................                                 S4.                 9.9999

S5.  Statutory Net Income Deduction (Line S1 times Line S4.  Cannot exceed $100,000)...                                                  S5.            99999999999
       Enter here and on Line 3, above.
                                                        Page 2
                                                                                                                                                      2018 BIRT-EZ P2 Vendor 9-21-2018

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                               2018 Business Income & Receipts Tax Page 1 
   
                                        Form Barcode Number: 0618 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/60 
    Bottom Right Reg. Mark                                         79/60 
                                                                   
    Name & Address Line 1                       40                 7/10 to 46/10 
    Name & Address Line 2                       40                 7/11 to 46/11 
    Name & Address Line 3                       40                 7/12 to 46/12 
    Name & Address Line 4                       40                 7/13 to 46/13 
    Name & Address Line 5                       40                 7/14 to 46/14 
    E-mail Address                              30                 50/15 to 79/15 
    Change of Address Box                       1                  44/16 to 44/16 
                                                                   
    City Account Number                         7                  67/8 to 73/8 
    Federal Identification Number               9                  66/10 to 74/10 
    Social Security Number                      9                  66/12 to 74/12 
                                                                   
    Termination Date                            10                 59/18 to 68/18 
    Amended Return Check Box                    1                  79/20 to 79/20 

    Line 1                                      7                  68/23 to 74/23 
    Line 2                                      7                  68/25 to 74/25 
    Line 3                                      7                  68/27 to 74/27 
    Line 4                                      7                  68/29 to 74/29 
    Line 5                                      7                  68/31 to 74/31 
    Line 6a                                     7                  68/34 to 74/34 
    Line 6b                                     7                  68/36 to 74/36 
    Line 6c                                     7                  68/38 to 74/38 
    Line 7                                      7                  68/40 to 74/40 
    Line 8                                      7                  68/42 to 74/42 
    Line 9                                      7                  68/44 to 74/44 
    Line 10a                                    7                  68/47 to 74/47 
    Line 10b                                    7                  68/49 to 74/49 
    Line 10c                                    7                  68/51 to 74/51

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                                        2018 BIRT Schedule B 
   
                                        Form Barcode Number: 0718 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4      Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils   Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5       Bottom Barcode Narrow to Width Ratio:   2.5 
  
            Line 2i and Line 6 are numeric and punctuation (decimal point) 
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/63 
    Bottom Right Reg. Mark                                         79/63 
                                                                   
    City Account Number                         7                  63/5 to 68/5 
                                                                   
    Line 1 Check Box                            1                  61/12 to 61/12 
    Line 1                                      9                  67/12 to 75/12 
    Line 2a                                     9                  67/17 to 75/17 
    Line 2b Check Box                           1                  61/19 to 61/19 
    Line 2b                                     9                  67/19 to 75/19 
    Line 2c Check Box                           1                  61/21 to 61/21 
    Line 2c                                     9                  67/21 to 75/21 
    Line 2d Check Box                           1                  61/23 to 61/23 
    Line 2d                                     9                  67/23 to 75/23 
    Line 2e                                     9                  68/27 to 75/27 
    Line 2f Check Box                           1                  61/29 to 61/29 
    Line 2f                                     9                  67/29 to 75/29 
    Line 2g                                     9                  67/31 to 75/31 
    Line 2h                                     9                  67/33 to 75/33 
    Line 2i                                     8                  68/35 to 75/35 
    Line 2j Check Box                           1                  61/37 to 61/37 
    Line 2j                                     9                  67/37 to 75/37 
    Line 3 Check Box                            1                  61/39 to 61/39 
    Line 3                                      9                  67/39 to 75/39 
    Line 4 Check Box                            1                  61/41 to 61/41 
    Line 4                                      9                  67/41 to 75/41 
    Line 5 Check Box                            1                  61/43 to 61/43 
    Line 5                                      9                  67/43 to 75/43 
    Line 6                                      8                  68/45 to 75/45 
    Line 7 Check Box                            1                  61/47 to 61/47 
    Line 7                                      9                  67/47 to 75/47 
    Line 8 Check Box                            1                  61/49 to 61/49 
    Line 8                                      9                  67/49 to 75/49 
    Line 9 Check Box                            1                  61/51 to 61/51 
    Line 9                                      9                  67/51 to 75/51 
    Line 10                                     9                  67/53 to 75/53 
    Line 11                                     9                  67/55 to 75/55 
    Line 12 Check Box                           1                  61/57 to 61/57 
    Line 12                                     9                  67/57 to 75/57 
    Line 13                                     9                  67/59 to 75/59

- 12 -

                                        2018 BIRT Schedule C-1 
   
                                        Form Barcode Number: 0818 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
           If Line 12 is equal to 100%, the BIRT-EZ return must be used 
   
                               Line 3 is numeric and punctuation (decimal point) 
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/60 
    Bottom Right Reg. Mark                                         79/60 
                                                                   
    City Account Number                         7                  64/5 to 70/5 
                                                                   
    Line 1                                      11                 65/40 to 75/40 
    Line 2                                      11                 65/42 to 75/42 
    Line 3                                      8                  68/44 to 75/44

- 13 -

                                        2018 BIRT Schedule D 
   
                                        Form Barcode Number: 0918 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/63 
    Bottom Right Reg. Mark                                         79/63 
                                                                   
    City Account Number                         7                  63/5 to 69/5 
                                                                   
    Line 1                                      11                 65/16 to 75/16 
    Line 2                                      11                 65/18 to 75/18 
    Line 3                                      11                 65/20 to 75/20 
    Line 4                                      11                 65/22 to 75/22 
    Line 5a                                     11                 65/24 to 75/24 
    Line 5b                                     11                 65/26 to 75/26 
    Line 5c                                     11                 65/28 to 75/28 
    Line 5d                                     11                 65/30 to 75/30 
    Line 6                                      11                 65/32 to 75/32 
    Line 7                                      11                 65/34 to 75/34 
    Line 8                                      11                 65/36 to 75/36 
    Line 9                                      11                 65/38 to 75/38 
    Line 10                                     11                 65/40 to 75/40 
    Line 11                                     11                 65/42 to 75/42 
    Line 12                                     11                 65/44 to 75/44 
    Line 13                                     11                 65/46 to 75/46 
   
                                             Worksheet S 
   
    Line S1                                     11                 65/50 to 75/50 
    Line S2                                     11                 65/52 to 75/52 
    Line S3                                     11                 65/54 to 75/54 
    Line S4                                     6                  70/56 to 75/56 
    Line S5                                     11                 65/58 to 75/58

- 14 -

                                        2018 BIRT Schedule A 
   
                                        Form Barcode Number: 1018 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4      Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils   Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5       Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/63 
    Bottom Right Reg. Mark                                         79/63 
                                                                   
    City Account Number                         7                  65/5 to 71/5 
                                                                   
    Line 1 Check Box                            1                  62/20 to 62/20 
    Line 1                                      9                  68/20 to 76/20 
    Line 2 Check Box                            1                  62/22 to 62/22 
    Line 2                                      9                  68/22 to 76/22 
    Line 3 Check Box                            1                  62/24 to 62/24 
    Line 3                                      9                  68/24 to 76/24 
    Line 4 Check Box                            1                  62/26 to 62/26 
    Line 4                                      9                  68/26 to 76/26 
    Line 5 Check Box                            1                  62/28 to 62/28 
    Line 5                                      9                  68/28 to 76/28 
    Line 6 Check Box                            1                  62/30 to 62/30 
    Line 6                                      7                  68/30 to 76/30 
    Line 7 Check Box                            1                  62/32 to 62/32 
    Line 7                                      9                  68/32 to 76/32 
    Line 8                                      8                  68/34 to 7634 
    Line 9 Check Box                            1                  62/36 to 62/36 
    Line 9                                      9                  68/36 to 76/36 
    Line 10 Check Box                           1                  62/38 to 62/38 
    Line 10                                     9                  68/38 to 76/38 
    Line 11 Check Box                           1                  62/40 to 62/40 
    Line 11                                     9                  68/40 to 76/40 
    Line 12                                     9                  68/42 to 76/42 
    Line 13                                     9                  62/44 to 62/44 
    Line 14 Check Box                           1                  62/46 to 62/46 
    Line 14                                     9                  68/46 to 76/46 
    Line 15                                     9                  68/48 to 76/48

- 15 -

                                        2018 BIRT Schedule E 
   
                                        Form Barcode Number: 1118 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/60 
    Bottom Right Reg. Mark                                         79/60 
                                                                   
    City Account Number                         7                  63/5 to 68/5 
                                                                   
    Line 1                                      11                 67/16 to 77/16 
    Line 2                                      11                 67/18 to 77/18 
    Line 3                                      11                 67/20 to 77/20 
    Line 4                                      11                 67/22 to 77/22 
                                                                   
    Line 5                                      11                 67/27 to 77/27 
    Line 6a                                     11                 67/30 to 77/30 
    Line 6b                                     11                 67/32 to 77/32 
    Line 7                                      11                 67/34 to 77/34 
    Line 8                                      11                 67/36 to 77/36 
    Line 9                                      11                 67/38 to 77/38 
                                                                   
    Line 10                                     11                 67/43 to 77/43 
    Line 11a                                    11                 67/46 to 77/46 
    Line 11b                                    11                 67/48 to 77/48 
    Line 12                                     11                 67/50 to 77/50 
    Line 13                                     11                 67/52 to 77/52 
    Line 14                                     11                 67/54 to 77/54 
    Line 15                                     11                 67/56 to 77/56

- 16 -

                                        2018 BIRT Worksheet N 
   
                                        Form Barcode Number: 1718 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:              40/4      Bottom Barcode X/Y Position:               57/63 
  Top Barcode Narrow Bar Width:          15 mils   Bottom Barcode Narrow Bar Width:           20 mils 
  Top Barcode Narrow to Width Ratio:     2.5       Bottom Barcode Narrow to Width Ratio:      2.5 
  
    Field                                        # of chars.              X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                                    6/4 
    Top Right Reg. Mark                                                   79/4 
    Bottom Left Reg. Mark                                                 6/63 
    Bottom Right Reg. Mark                                                79/63 
                                                                   
    City Account Number                          7                        63/5 to 69/5 
   
                                      Section 1 for BIRT Long Form Filers 
   
    Line 1 Check Box                             1                        58/15 to 58/15 
    Line 1                                       9                        67/15 to 75/15 
                                                              
    Line 3                                       9                        67/22 to 75/22 
   
                                        Section 2 for BIRT - EZ Filers 
   
    Line 1 Check Box                             1                        58/31 to 58/31 
    Line 1                                       9                        67/31 to 75/31 
                                                              
    Line 3                                       9                        67/38 to 75/38 
   
                                         Section 3 for BIRT H-J Filers 
   
    Line 1 Check Box                             1                        58/48 to 58/48 
    Line 1                                       9                        67/48 to 75/48 
                                                              
    Line 3                                       9                        67/55 to 75/55

- 17 -

                                        2018 BIRT Schedule SC 
   
                                        Form Barcode Number: 1618 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4      Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils   Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5       Bottom Barcode Narrow to Width Ratio:   2.5 
  
    Field                                       # of chars.        X/Y Start Position 
                                                                   
    Top Left Reg. Mark                                             6/4 
    Top Right Reg. Mark                                            79/4 
    Bottom Left Reg. Mark                                          6/63 
    Bottom Right Reg. Mark                                         79/63 
                                                                   
    City Account Number                         7                  62/5 to 68/5 
   
    Line 1                                      9                  67/22 to 75/22 
    Line 2                                      9                  67/25 to 75/25 
    Line 3                                      9                  67/28 to 75/28 
    Line 4                                      9                  67/31 to 75/31 
    Line 5                                      9                  67/34 to 75/34 
    Line 6                                      9                  67/37 to 75/37 
    Line 7                                      9                  67/40 to 75/40 
    Line 8                                      9                  67/43 to 75/43 
    Line 9                                      9                  67/46 to 75/46 
    Line 10                                     9                  67/49 to 75/49 
    Line 11                                     9                  67/52 to 75/52 
    Line 12                                     9                  67/55 to 75/55 
    Line 13                                     9                  67/58 to 75/58

- 18 -

2018 BIRT
CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE DUE DATE: APRIL 15, 2019
2018 BUSINESS INCOME & RECEIPTS TAX
For business conducted in and out of Philadelphia City Account Number
7777777

If your business terminated in 2018, enter the termination date AND file a CHANGE FORM. mm-dd-yyyy

YOU MUST COMPLETE WORKSHEET "S" and SCHEDULE "C-1" If this is an amended return place an "X" here: X
COMPUTATION OF TAX DUE OR OVERPAYMENT
1. NET INCOME PORTION OF TAX (from Schedule B, Line 13 or
Schedule A, Line 15. If there is no tax due, enter "0"................................................................... 1. 9999999
2. GROSS RECEIPTS PORTION OF TAX (from Schedule D, Line 13).
If there is no tax due, enter "0"...................................................................................................... 2. 9999999

3. Tax Due for the 2018 Business Income & Receipts Tax (Line 1 plus Line 2).............................. 3. 9999999

4. MANDATORY 2019 BIRT Estimated Payment (See Instructions) .......................................... 4. 9999999

5. Total Due by 4/15/2019 (Line 3 plus Line 4)................................................................................ 5. 9999999
ESTIMATED PAYMENTS AND OTHER CREDITS
6a. Include any estimated and/or extension payments of 2018 BIRT previously made,
and any credit from overpayment of the 2017 BIRT and/or 2018 NPT return....................... 6a. 9999999

6b. Credit from Special Credit Schedule (SC). (Cannot exceed amount on Line 3).........................6b. 9999999

6c. Total payments and credits. (Line 6a plus Line 6b)..................................................................... 6c. 9999999
7. Net Tax Due (Line 5 less Line 6c).
If Line 6c is greater than Line 5, enter "0".......................................................................................7. 9999999
8. Interest and Penalty
Refer to web site for current percentage........................................................................................ 8. 9999999
9. TOTAL DUE including Interest and Penalty (Line 7 plus Line 8).
Use payment coupon. Make check payable to: "City of Philadelphia"................................. 9. 9999999

OVERPAYMENT OPTIONS If Line 6C is greater than Line 5, enter the amount to be:
10a. Refunded. Do not file a separate Refund Petition............................................................. 10a. 9999999

10b. Applied to the 2018 Net Profits Tax Return.................................................................................10b. 9999999

10c. Applied to the 2019 Business Income & Receipts Tax................................................................10c. 9999999

Preparer Signature_________________________________________ Date_______________________Phone #_________________________

2018 BIRT P1 Vendor 9-28-2018
Page 1

- 19 -

         CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE                                                                                           City Account Number
          2018 BIRT  SCHEDULE B                                                                                                                   7777777
COMPUTATION OF TAX ON NET INCOME (METHOD II)
Reminder -   You   must use the same method (METHOD I or METHOD II) that you elected on the first Business Income & Receipts Tax return
filed.    If you are using Schedule B, do not complete or file Schedule A.
Note:  If any entry on this schedule exceeds $999,999,999 - See special mailing instructions below Schedule A.

1.  Net Income (Loss) as properly reported to the Federal Government...........................................1.                               X 999999999

2.    ADJUSTMENTS   (Per BIRT Reg. 404 and Public Law 86-272)
(a) Income net of interest expense attributable to direct obligations of the Federal
     Government, Pennsylvania or the political subdivisions of Pennsylvania.
     (If less than zero, enter zero on this line).............................................................................. 2a.               999999999

(b)  Net Income (Loss) from certain port related activities.   (Reg. 302 (T)).............................. 2b.                                 X 999999999
(c)  Net Income (Loss) from  specific PUC and ICC business activities.
      (Reg. 101 (D)(3))................................................................................................................... 2c.  X 999999999

(d)  Net Income (Loss) from Public Law 86-272 activities.......................................................... 2d.                          X 999999999

(e)  Receipts by corporations of dividends, interest and royalties received from other
      corporations in the same affiliated group and/or from other corporations of which
      the receiving corporation owns at least 20% of the stock and/or
      BIRT Regulation §404 (B)(5) adjustments (Reg. 302 (O))................................................... 2e.                               999999999

(f)  Line 1 minus Lines 2a through 2e.......................................................................................... 2f.             X 999999999
(g)  All other receipts from other corporations of the same affiliated group.
      (Reg. 302 (N))....................................................................................................................... 2g.   999999999

(h)  Gross Receipts per BIRT Regulation §404(B)(5)(e)............................................................ 2h.                             999999999

(i)  Divide Line g by Line h and enter the result here................................................................... 2i.                     9.999999

(j)  Multiply Line f by Line i and enter the result here................................................................... 2j.                 X 999999999

 3.  ADJUSTED NET INCOME (LOSS)  (Line 2f minus Line 2j)........................................................ 3.                             X 999999999

 4.  Total Nonbusiness Income (Loss)................................................................................................ 4.         X 999999999

 5.  Income (Loss) to be apportioned (Line 3 minus Line 4).............................................................. 5.                     X 999999999

 6.  Apportionment Percentage from Schedule C-1, Line 3............................................................... 6.                         9.999999

 7.  Income (Loss) apportioned to Philadelphia (Line 5 times Line 6)................................................ 7.                         X 999999999

 8.  Nonbusiness Income (Loss) allocated to Philadelphia................................................................ 8.                     X 999999999

 9.  Current year Income (Loss) (Line 7 plus Line 8).......................................................................... 9.               X 999999999
10.    Statutory Net Income Deduction from Worksheet S, Line S5.
         (Must complete Schedule C-1.)...............................................................................................10.          999999999

11.  Loss Carry Forward, if any.........................................................................................................11.       999999999

12.  Taxable Income (Loss) (Line 9 minus Line 10 minus Line 11)..................................................12.                            X 999999999

13.    TAX DUE   (Line 12 times .0630)   If Line 12 is a loss, enter zero..............................................13.                        999999999
      ENTER HERE AND ON PAGE 1, LINE 1 OF THIS RETURN.

                                                                                                                                                2018 Sch.B Vendor  9-28-2018

- 20 -

CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE City Account Number
2018 BIRT SCHEDULE C-1 7777777
For business conducted in and out of Philadelphia

The Department has adopted a Single Sales/Receipts Factor Apportionment methodology for BIRT.
The Property and Payroll Factors are no longer used in the calculation of the Philadelphia Apportionment
percentage. The Single Sales/Receipts Factor Apportionment percentage is the ratio of Philadelphia
Sales/Receipts to Total Sales/Receipts everywhere .

The sourcing of sales/receipts is the same as it has been in prior years. Receipts and Taxable Receipts
are defined at Philadelphia Code § 19-2601 and explained in Article III of the BIRT Regulations.

www.phila.gov/revenue/birt-regs

Market-Based Sourcing of Service/Sales for Software Companies

A Software Company (as defined by BIRT Regulations Section 101DD) is to source sales/receipts (for
both the Receipts and Net Income bases) in accordance with Market-based sourcing. That is, the sale
of products and the performance of services will be deemed to be the location where the recipient
receives the benefit of the products and services.

This schedule must be completed in order to receive the deduction from Worksheet S.

COMPUTATION OF APPORTIONMENT FACTOR TO BE APPLIED TO APPORTIONABLE NET INCOME. YOU
MUST COMPLETE SCHEDULE C-1 IF YOU ARE APPORTIONING YOUR INCOME. FAILURE TO INCLUDE THIS SCHEDULE WITH YOUR
RETURN MAY RESULT IN THE DISALLOWANCE OF YOUR APPORTIONMENT AND YOU MAY BE BILLED.

1. Philadelphia Sales/Receipts (From Schedule D line 6).........................................................1. 99999999999

2. Gross Sales/Receipts Everywhere (From Schedule D line 4).............................................. 2. 99999999999

3. Single Sales/Receipts Factor Apportionment Percentage (Line 1 divided by 2).................. 3. 9.999999

ENTER THE PHILADELPHIA RECEIPTS FACTOR APPORTIONMENT PERCENTAGE ON SCHEDULE A, LINE 8 OR SCHEDULE B, LINE 6.

DO NOT FILE THIS RETURN if Line 3 is equal to 100%. Use the BIRT-EZ return which is available at
www.phila.gov/revenue.

Do not submit Schedule C-1 with the BIRT-EZ return.

2018 Sch. C-1 Vendor 12-14-2018

- 21 -

CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE City Account Number
2018 BIRT SCHEDULE D 7777777
COMPUTATION OF TAX ON GROSS RECEIPTS

The following taxpayers should not file Schedule D.
· Taxpayers registered under the Pennsylvania Securities Act of 1972;
· Persons subject to a tax imposed pursuant to Article VII, VIII, IX or XV of the Tax Reform Code of 1971 (Banks, Title Insurance Companies,
Trust Companies, Insurance Companies and Mutual Thrift Institutions)
· Other Financial Businesses
These industries should file Schedules H-J, available on our website at www.phila.gov/revenue.

Do not report negative numbers on this schedule.
1. Gross Receipts from sales and/or rentals of tangible personal property, dividends,
interest, royalties, and gains on sale of stocks, bonds and business capital assets....................1. 99999999999

2. Gross Receipts from services...................................................................................................... 2. 99999999999

3. Gross Receipts from rentals of real property................................................................................3. 99999999999

4. Total of Lines 1 through 3.............................................................................................................4. 99999999999
5. Less exclusions from:
5a. Sales delivered outside of Philadelphia............................................................................ 5a. 99999999999

5b. Services performed outside of Philadelphia......................................................................5b. 99999999999

5c. Rentals of real property outside of Philadelphia................................................................5c. 99999999999

5d. Other (specify)_______________________.................................................................... 5d. 99999999999

6. Net Taxable Receipts before Statutory Exclusion (Line 4 minus Lines 5a through 5d).............. 6. 99999999999

7. Statutory Exclusion (Lower of Line 6 or $100,000.00)............................................................ 7. 99999999999

8. Net Taxable Receipts after Statutory Exclusion (Line 6 minus Line7)........................................ 8. 99999999999
9. Receipts on which tax is to be computed by the Alternate Method.
(Enter here and on Schedule E, Line 1, 5 or 10.)........................................................................ 9. 99999999999

10. Receipts subject to tax at the regular rate (Line 8 minus Line 9)...............................................10. 99999999999

11. TAX DUE at the regular rate. (Line 10 times .001415)..............................................................11. 99999999999

12. TAX DUE using the Alternate Method from Schedule E, Line 15, if applicable.........................12. 99999999999

13. TOTAL TAX DUE (Line 11 plus Line 12)...................................................................................13. 99999999999
Enter here and on Page 1, Line 2 of this return.

Worksheet S - Use to calculate Statutory Net Income Deduction
S1. Enter the lower of Line 6 above or $100,000........................................................................ S1. 99999999999
S2. Enter Current Year Income from Line 11 of Schedule A or Line 9 of Schedule B.
If loss, enter zero................................................................................................................... S2. 99999999999

S3. Enter Net Taxable Receipts from Line 6 above.................................................................... S3. 99999999999

S4. Divide Line S2 by Line S3. (Cannot be greater than 1.0000).............................................. S4. 9.9999

S5. Statutory Net Income Deduction (Line S1 times Line S4. Cannot exceed $100,000)......... S5. 99999999999
Enter here and on Line 12 of Schedule A or Line 10 of Schedule B.

2018 Sch. D Vendor 9-28-2018

- 22 -

CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE City Account Number
2018 BIRT SCHEDULE A 7777777
COMPUTATION OF TAX ON NET INCOME (METHOD I)

To be used by taxpayers electing to report net income from the operation of a business in accordance with their accounting system, after
subtracting from gross receipts the cost of goods sold and all ordinary and necessary expenses of doing business, rather than as reported
to and ascertained by the Federal Government.
Reminder - You must use the same method (METHOD I or METHOD II) that you elected on the first Business Income and Receipts Tax
return filed. If you are using Schedule A, do not complete or file Schedule B.

Note: If any entry on this schedule exceeds $999,999,999 - See special mailing instructions below.

1. Net Income (Loss) per accounting system used plus income taxes deducted
in arriving at Net Income............................................................................................................ 1. X 999999999

2. Net Income (Loss) from certain port related activities............................................................... 2. X 999999999

3. Net Income (Loss) from specific PUC and ICC business activities.......................................... 3. X 999999999

4. Net Income (Loss) from Public Law 86-272 activities............................................................... 4. X 999999999

5. Adjusted Net Income (Loss) (Line 1 minus Lines 2, 3 and 4).................................................... 5. X 999999999

6. Total Nonbusiness Income (Loss)............................................................................................. 6. X 999999999

7. Income (Loss) to be apportioned (Line 5 minus Line 6)............................................................ 7. X 999999999

8. Apportionment Percentage from Schedule C-1, Line 3............................................................ 8. 9.999999

9. Income (Loss) apportioned to Philadelphia (Line 7 times Line 8)...................................... 9. X 999999999

10. Nonbusiness Income (Loss) allocated to Philadelphia............................................................ 10. X 999999999

11. Current year Income (Loss) (Line 9 plus Line 10)................................................................... 11. X 999999999
12. Statutory Net Income Deduction from Worksheet S, Line S5.
(Must complete Schedule C-1.)............................................................................................
12. 999999999
13. Loss Carry Forward, if any...................................................................................................... 13. 999999999

14. Taxable Income (Loss) (Line 11 minus Line 12 minus Line 13)............................................ 14. X 999999999

15. TAX DUE (Line 14 times .0630) If Line 14 is a loss, enter zero............................................ 15. 999999999
ENTER HERE AND ON PAGE 1, LINE 1 OF THIS RETURN.

Special Mailing Instructions for Schedules A and B

If your entry for any line exceeds 999,999,999., include a cover letter with your
return indicating the correct entries for Schedule A or B and request manual
processing of the return to assure proper entry of your accounting data.

2018 Sch. A Vendor 1-2-2019

- 23 -

       CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE                                                                                               City Account Number
              2018 BIRT  SCHEDULE  E                                                                                                                   7777777
       COMPUTATION OF TAX ON GROSS RECEIPTS

ALTERNATE METHOD OF COMPUTING TAX ON GROSS RECEIPTS
(To be used by Manufacturers, Wholesalers and Retailers electing to use the Alternate Method of computation.)
SEE BUSINESS INCOME AND RECEIPTS TAX REGULATIONS (SECTION 305) AT   WWW.PHILA.GOV/REVENUE.

A.  MANUFACTURERS

 1.  Receipts on which tax is to be computed by the Alternate Method (from Schedule D, Line 9)................. 1.                                     99999999999

 2.  Cost of goods sold for the receipts reported on Line 1.............................................................................. 2.           99999999999

 3.  TAX BASE (Line 1 minus Line 2)............................................................................................................... 3.  99999999999

 4.    TAX DUE (Line 3 times .0234).  If Line 3 is a loss, enter zero................................................................... 4.            99999999999

B.  WHOLESALERS

 5.  Receipts on which tax is to be computed by the Alternate Method (from Schedule D, Line 9)................. 5.                                     99999999999

 6.  Applicable Cost of Goods for the receipts reported on Line 5:
              (a) Cost of material.............................................................................................................. 6a.   99999999999

              (b) Cost of Labor................................................................................................................. 6b.   99999999999

 7.  TOTAL APPLICABLE COST OF GOODS (Line 6a plus 6b)..................................................................... 7.                          99999999999

 8.  TAX BASE (Line 5 minus Line 7)............................................................................................................... 8.  99999999999

 9.    TAX DUE (Line 8 times .0329).  If Line 8 is a loss, enter zero................................................................... 9.            99999999999

C.  RETAILERS

10.  Receipts on which tax is to be computed by the Alternate Method (from Schedule D, Line 9)............... 10.                                      99999999999

11.  Applicable Cost of Goods for the receipts reported on Line 10:
              (a) Cost of material............................................................................................................... 11a. 99999999999

              (b) Cost of Labor.................................................................................................................. 11b. 99999999999

12.  TOTAL APPLICABLE COST OF GOODS (Line 11a plus 11b)...............................................................                            12.  99999999999

13.  TAX BASE (Line 10 minus Line 12)......................................................................................................... 13.     99999999999

14.    TAX DUE (Line 13 times .0078).  If Line 13 is a loss, enter zero............................................................. 14.               99999999999

15.    TOTAL TAX DUE   (Total of Lines 4, 9 and 14)......................................................................................... 15.       99999999999
  Enter the amount from Line 15 on Schedule D, Line 12.

                                                                                                                                                  2018 Sch. E Vendor 9-28-2018

- 24 -

CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE City Account Number
2018 BIRT SCHEDULE SC 7777777
SPECIAL CREDIT SCHEDULE
Important Note

Schedule SC is to be used by a taxpayer participating in any of the BIRT Tax Credit Programs (listed below) in order to
claim the applicable credit on their 2018 BIRT return. A taxpayer must have made an application to participate in and
been accepted into the respective program by the Revenue Department. Also, the taxpayer must fulfill all statutory and
regulatory requirements to participate in the respective Tax Credit Program (e.g., entering into commitment agreements
with the Department and complying with its terms and conditions, tax compliance, etc.). A taxpayer not meeting all the
requirements for participation in the respective BIRT Tax Credit Program will not receive the applicable credit.

For more information on the various BIRT Tax Credit Programs, please refer to the Department's website at
http://www.phila.gov/Revenue/taxpro/Pages/TaxCredits.aspx.

1. Credit for Contributions to Community Development Corporations,
(Nonprofit Organizations engaged in developing and implementing
Healthy Food Initiatives and Nonprofit Intermediaries)........................................................................ 1. 999999999

2. Credit for New Job Creation................................................................................................................. 2. 999999999

3. Green Roof Tax Credit......................................................................................................................... 3. 999999999

4. Philadelphia Re-Entry Employment Program for
Returning Citizens Tax Credit ("PREP")............................................................................................... 4. 999999999

5. Sustainable Business Tax Credit......................................................................................................... 5. 999999999

6. Credit for Employment of Returning Veterans of the Armed Forces.................................................... 6. 999999999

7. Life Partner and Transgender Care Health Benefits Tax Credits........................................................ 7. 999999999

8. Distressed Business Tax Credit........................................................................................................... 8. 999999999

9. Keystone Opportunity Zones Tax Credits (KOZ/KOEZ/KOIZ)
from KOZ Worksheet Line 10............................................................................................................... 9. 999999999

10. Strategic Development Area Tax Credit............................................................................................. 10. 999999999

11. Economic Development District Tax Credit........................................................................................ 11. 999999999

12. Healthy Beverage Tax Credit.............................................................................................................. 12. 999999999

13. TOTAL CREDITS (Add Lines 1 through 12)......................................................................................13. 999999999
Enter the amount of Line 13 on Page 1, Line 6b of the 2018 BIRT or BIRT-EZ Return.
(Cannot exceed amount on Page 1, Line 3.)

2018 Sch. SC Vendor 9-28-2018

- 25 -

2018 BIRT and NPT Returns City Account Number
WORKSHEET N
New Business and Employment Worksheet 7777777
(Philadelphia Code 19-3800)
To be used by taxpayers who are claiming new business status under Philadelphia code 19-3800.
Taxpayer must first complete the eligibility questionnaire to use this worksheet.
For Business Income & Receipts Tax Long Form Filers
COMPUTATION OF TAX ON NET INCOME
1. Enter the amount of taxable income from Schedule A, Line 14 or Schedule B, Line 12.
To report a net loss, check the box..........................................................................................1. X 999999999

2. Tax Due as computed for new business................................................................................. 2. 0.00
Enter the amount of Line 2 on BIRT Page 1, Line 1 and if liable, NPT Page 1, Line 11.

COMPUTATION OF TAX ON GROSS RECEIPTS

3. Enter the taxable gross receipts from Schedule D, Line 8.................................................... 3. 999999999

4. Tax Due as computed for new business............................................................................... 4. 0.00
Enter the amount of Line 4 on BIRT Page 1, Line 2.
For Business Income & Receipt Tax - EZ Filers

COMPUTATION OF TAX ON NET INCOME

1. Enter the amount of taxable income from BIRT-EZ Page 2, Line 5
To report a net loss, check the box.......................................................................................... 1. X 999999999

2. Tax Due as computed for new business................................................................................. 2. 0.00
Enter the amount of Line 2 on BIRT-EZ Page 1, Line 1 and if liable, NPT Page 1, Line 11.

COMPUTATION OF TAX ON GROSS RECEIPTS

3. Enter the taxable gross receipts from BIRT-EZ Page 2, Line 10............................................ 3. 999999999

4. Tax Due as computed for new business................................................................................. 4. 0.00
Enter the amount of Line 4 on BIRT-EZ Page 1, Line 2.

For Business Income & Receipts Tax Schedule H-J Filers

COMPUTATION OF TAX ON NET INCOME

1. Enter the amount of taxable income from Schedules H-J (Schedule A or B),
Line 12 or (Schedule H-1), Line 11. To report a net loss, check the box............................... 1. X 999999999

COMPUTATION OF TAX ON GROSS RECEIPTS

3. Enter the taxable gross receipts from Schedule H-J (Schedule H), Line 10 or 24.................. 3. 999999999

4. Tax Due as computed for new business.................................................................................. 4. 0.00
Enter the amount of Line 4 on BIRT Page 1, Line 2.

Important Note: Use Worksheet N to complete Page 1 of the BIRT return and if liable, Page 1 of the NPT return, Line 11.
2018 Worksheet N Vendor 9-28-2018

- 26 -

2018 Business Income & Receipts and Net Profits Taxes General Information

Tax regulations and forms are available at www.phila.gov/revenue.

When and Where to File - The 2018 Business Income and Receipts and Net Profits taxes are due by April 15, 2019. A
return must be filed even if an overall loss is incurred. Failure to file a return by the due date could result in the imposition
of fines, legal costs and non-filer penalties. Payment of tax can be made using coupons available on our website at
www.phila.gov/tax-forms. Payments can be made using e-check, credit card, or debit card. E-CHECK IS FREE. Do not
enclose payments with your tax return.

Important Mailing Information! If requesting a refund on either the BIRT or NPT return, both returns must be mailed together to
P.O. Box 1137 to receive proper credit and to enable prompt processing of your refund request. If both returns are not mailed together
your refund request may be denied.

Mail payments to: Mail returns requesting a refund to: Mail returns not requesting a refund to:
City of Philadelphia City of Philadelphia City of Philadelphia
Department of Revenue Department of Revenue Department of Revenue
P.O. Box 1393 P.O. Box 1137 P.O. Box 1660
Philadelphia, PA 19105-1393 Philadelphia, PA 19105-1137 Philadelphia, PA 19105-1660

Effective January 1st, 2018 any Business Income and Receipts or Net Profits Tax due April 17, 2018 and later
where the tax due on the return is $5,000.00 or greater is now required to be paid electronically. To file and pay go
to www.phila.gov/revenue. A user fee is added when paying by credit card. E-CHECK IS FREE.

ACH Debits and Credits are accepted for payment of tax. For more information or to enroll in this program go to
www.phila.gov/eft-ach. Contact the Electronic Government Unit at 215-686-6582, 6579 or 6628 or e-mail
egovservices@phila.gov.

Returned Checks. If your check is returned unpaid for insufficient or uncollected funds, (1) you authorize The City of
Philadelphia or its agent to make a one-time electronic funds transfer from your account to collect a fee of $20; and (2)
The City of Philadelphia or its agent may re-present your check electronically to your depository institution for payment.

Change Form - If your business terminated, changed organization or entity, complete a Change Form found at
www.phila.gov/tax-change. If you maintain a Commercial Activity license but did not actively engage in business during
2018, complete a Change Form to indicate that you are not in business. Do not file the 2018 Business Income and
Receipts and/or Net Profits tax returns. If you begin a business again with the same Federal Identification or Social
Security number you should reinstate your Philadelphia tax account number. In this scenario, you will not have to pay for
an additional commercial activity license. If there was a change of business entity (e.g., individual proprietorship to
corporation), you need a new Philadelphia Tax Account Number and commercial activity license. Register online for a tax
account number at www.phila.gov/revenue.

To report a change of address, check the box on Page 1 of the return and file a Change Form.

A mandatory estimated tax payment towards the 2019 Business Income and Receipts Tax is required for all
businesses operating in Philadelphia. This estimate is equal to 100% of the 2018 tax liability, as indicated on Line
3, prior to the application of any tax credits from 6b. Enter the amount of Line 3 on Line 4 of the return. If you
enter an amount on Line 4 less than the amount on Line 3, you may be billed additional interest and penalty.

Take credit for any 2018 BIRT or NPT payments previously made as a result of estimated payments, applied
overpayments or extension payments.

Neatly print or type all information. Do not staple, fold or submit photocopies of the tax return. Do not submit
copies of Federal Returns. File only required schedules.

If your business started in 2018 and has been approved as a New Business as defined under
Philadelphia Code 19-3800 and has subsequently met or will meet the employment
requirements, then use Worksheet N to complete the Business Income & Receipts and Net
Profits tax return. It can be downloaded from the forms section at www.phila.gov/revenue in
the "Tax Forms & Instructions" section .

2018 BIRT-NPT Info 9-19-2018
Page 1

- 27 -

                                        2018 Business Income and Receipts Tax

If all business is conducted and/or located within Philadelphia, only the BIRT-EZ Pages 1 and 2 should be completed and filed.
If business is conducted and/or located both in and out of Philadelphia, only Page 1 of the BIRT return and the appropriate combination of Schedules A
through E should be completed and filed.
Taxpayers must use the same method (Schedule A, Method I or Schedule B, Method II) that they elected on the first Business Income and Receipts Tax
return filed.  Only Schedule A (Form 24715) or Schedule B (Form 24415) should be completed and filed.
You must complete Schedule C-1 (Form 24515) if you are apportioning your income.  Failure to include this schedule with the return may result in the
disallowance of your apportionment and you may be billed.  If Line 3 of Schedule C-1 is equal to 100%, the BIRT-EZ return must be filed instead.  An
exception to the required use of the BIRT-EZ return (for a taxpayer whose business activity is 100% within the City of Philadelphia) is in the case of a
manufacturer, wholesaler and/or retailer reporting the receipts base tax using the Alternate Receipts Tax Computation.  The Alternative Receipts Tax
Computation is calculated on BIRT Schedule E which would require the taxpayer to use 2018 BIRT (i.e. long form) with Schedule C-1 calculated to 100%.
 Schedule C-1 should not be completed or filed if the BIRT-EZ return is filed.
If your business started in 2018 and has been approved as a New Business as defined under Philadelphia Code 19-3800 and has subsequently
met or will meet the employment requirements, then use Worksheet N to complete the Business Income and Receipts and Net Profits tax
returns.  Worksheet N can be downloaded from   www.phila.gov/revenue in the "Tax Returns" section.

                                        2018 Net Profits Tax

Every individual residing in Philadelphia during 2018 and operating a business or other activity inside or outside of Philadelphia and
non-residents of Philadelphia, if engaged in such activities within Philadelphia, are subject to the Net Profits Tax.    Corporations are not
subject to the Net Profits Tax.

Every partnership, limited partnership, limited liability company filing with the IRS as a partnership, association, or other group of two or more persons
operating a business within Philadelphia, whether residents or non-residents of Philadelphia, is subject to the Net Profits Tax.  A partnership comprised
solely of corporate partners must file a Net Profits Tax return even if no tax liability exists.  The City of Philadelphia follows the Federal tax treatment for
LLCs.  If the LLC chose corporate tax treatment, it would not be liable for Net Profits Tax.  If the LLC chose to be treated as a partnership or as a
disregarded entity, treated for federal filing purposes as an individual, it would be liable for Net Profits Tax.
Every estate or trust is subject to the Net Profits Tax if the estate or trust is engaged in any business which is subject to the Net Profits Tax per Income
Regulation 220(A)(3).

                                        Interest, Penalties and Costs

Effective January 1, 2014 - All taxes (except Real Estate) bear simple interest.  The annual rate shall be the
Federal Short-Term Rate effective January 1 of such calendar year (26 § USCA 6621 et. seq.) plus five (5)
percentage points.

Penalty will be at the rate of 1¼% of the unpaid tax for each month or fraction thereof.

For current interest rates, see the Department of Revenue's website at   www.phila.gov/revenue.

                                                                                                                 2018 BIRT-NPT Info 9-19-2018
                                        Page 2

- 28 -

         Philadelphia Scan Line Data 
 
         2018 BIRT Payment Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  24
 
 6 – 11  Due Date - 041519 
 
 12 – 19 Zero filled 
 
 20 – 26 Business Tax Account Number 
 
 27 – 49 Zero filled 
 
 50 – 53 Period / Year - 1218 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 29 -

         Philadelphia Scan Line Data 
 
         2018 BIRT Extension Payment Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  24
 
 6 – 11  Due Date - 041519 
 
 12 – 19 Zero filled 
 
 20 – 26 Business Tax Account Number 
 
 27 – 49 Zero filled 
 
 50 – 53 Period / Year - 1318 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 30 -

2018 BIRT and BIRT-EZ EXTENSION WORKSHEET and PAYMENT COUPONS

This is an extension worksheet to be used when figuring the amount of Business Income & Receipts Tax you owe. You must file an actual return by the
extension due date to satisfy your filing requirements. Retain this worksheet for your records.
If an extension of time has been obtained from the Internal Revenue Service for filing your corporate, partnership or individual tax returns, the
corresponding returns are due on or before the due date of the federal extension(s) or 6/20/2019, whichever is later. You must pay 100% of the estimated
tax due by April 15, 2019. Filing an extension coupon does not extend the time to pay the tax. Interest and penalty shall be added to the amount of tax
not paid by the statutory due date. You will not receive written confirmation of your extension request. NOTE: If you have filed for an automatic federal
extension but do not believe you will owe any tax, you do not need to file an extension coupon.

1. 100% of estimated 2018 Business Income & Receipts tax due ............................................................. 1 .. 9999999 .00

2. Mandatory 2018 Business Income & Receipts estimated payment (repeat Line 1). .............................. 2 ... 9999999 .00

3. Total Tax Due (Line 1 plus Line 2) .......................................................................................................... 3 ..... 9999999 .00

4. Other payments and credits you expect to report on the 2018 BIRT return .............................................. 4... 9999999 .00
5. Tax Balance Due (Line 3 minus Line 4). Enter on the Extension Coupon.
If Line 4 is greater than Line 3, no extension coupon is needed. .............................................................. 5.. 9999999 .00
Detachhere
-----------------------------------------------------------------------------------------------------------------------------------------------
2018 BIRT and MANDATORY ESTIMATED 201 9BIRT Due Date: April 15, 2019
EXTENSION PAYMENT COUPON

TAXPAYER NAME Name and address
and ADDRESS Name and address
Name and address
CITY ACCOUNT #: 1234567

Estimated Tax Due 7777777 .00

Make check payable to: "City of Philadelphia"
Include your Account Number on your check or money order.

33324041519000000001234567000000000000000000000001318000000000000005

Detach here
-----------------------------------------------------------------------------------------------------------------------------------------------
2018 BIRT and MANDATORY ESTIMATED 201 9BIRT Due Date: April 15, 2019
PAYMENT COUPON

TAXPAYER NAME Name and address
and ADDRESS Name and address Tax Due 7777777 .00
Name and address
CITY ACCOUNT #: 1234567 Interest & Penalty 7777777 .00

Total Due 7777777 .00

Make check payable to: "City of Philadelphia"
Include your Account Number on your check or money order.

33324041519000000001234567000000000000000000000001218000000000000007

- 31 -

                                    2018 Net Profits Tax Return 
 
                                    Form Barcode Number: 1418 
                                    Barcode Type: Code 3 of 9 
                                      
Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
 
  Field                                       # of chars.       X/Y Start Position 
                                                                
  Top Left Reg. Mark                                            6/4 
  Top Right Reg. Mark                                           79/4 
  Bottom Left Reg. Mark                                         6/63 
  Bottom Right Reg. Mark                                        79/63 
                                                                
  Name & Address Line 1                       40                7/10 to 46/10 
  Name & Address Line 2                       40                7/11 to 46/11 
  Name & Address Line 3                       40                7/12 to 46/12 
  Name & Address Line 4                       40                7/13 to 46/13 
  Name & Address Line 5                       40                7/14 to 46/14 
                                                                
  E-mail Address                              30                51/15 to 80/15 
  Change of Address Box                       1                 32/16 to 32/16 
                                                                
  City Account Number                         7                 63/8 to 69/8 
  Federal Identification Number               9                 62/10 to 70/10 
  Social Security Number                      9                 62/12 to 70/12 
                                                                
  Percentage                                  3                 73/17 to 75/17 
  Amended Return Check Mark                   1                 32/18 to 32/18 
  Termination Date                            10                66/19 to 75/19 
                                                                
  Line 1 Check Box                            1                 65/23 to 65/23 
  Line 1                                      7                 70/23 to 76/23 
  Line 2                                      7                 70/24 to 76/24 
  Line 3 Check Box                            1                 65/26 to 65/26 
  Line 3                                      7                 70/26 to 76/26 
  Line 4                                      7                 70/27 to 76/27 
  Line 5                                      7                 70/28 to 76/28 
  Line 6 Check Box                            1                 65/30 to 65/30 
  Line 6                                      7                 70/30 to 76/30 
  Line 7                                      7                 70/31 to 76/31 
  Line 8 Check Box                            1                 65/33 to 65/33 
  Line 8                                      7                 70/33 to 76/33 
  Line 9                                      7                 70/34 to 76/34 
  Line 10                                     7                 70/35 to 76/35 
  Line 11                                     7                 70/37 to 76/37 
  Line 12a                                    7                 70/39 to 76/39 
  Line 12b                                    7                 70/40 to 76/40 
  Line 12c                                    7                 70/41 to 76/41 
  Line 13                                     7                 70/43 to 76/43 
  Line 14                                     7                 70/44 to 76/44 
  Line 15                                     7                 70/46 to 76/46 
  Line 16                                     7                 70/48 to 76/48 
  Line 17                                     7                 70/50 to 76/50 
  Line 18                                     7                 70/51 to 76/51 
  Line 19a                                    7                 70/53 to 76/53 
  Line 19b                                    7                 70/54 to 76/54 
  Line 19c                                    7                 70/55 to 76/55

- 32 -

                   CITY OF PHILADELPHIA                                                                                                                         2018 NPT
           2018 NET PROFITS TAX                                                                   DUE DATE:  APRIL 15, 2019
                                                                                                                                                              City Account Number
           CORPORATIONS ARE NOT SUBJECT TO THIS TAX
PROOF OF PRO RATA SHARE MUST BE ATTACHED (if applicable)                                                                                                        7777777

Name and address..................Line 1                                                          EIN                                                           999999999
Name and address..................Line 2
Name and address..................Line 3                                                          SSN                                                           999999999
Name and address..................Line 4
Name and address..................Line 5                                                           Taxpayer E-mail Address
                                                                                      aaaaaaaaaaaaaaaaaaaaaaaaaa.ddd
If this is a change of address, check this box:            X
and file a Change Form.                                                  Percentage from Page 3, Worksheet D, Line 3, if applicable:
                                                                                                                                                                                         99%
If this is an amended return place an "X" here:            X
           If your business terminated in 2018, enter the termination date AND file a CHANGE FORM.                                                                   mm-dd-yyyy
                                                                                                   
IF YOU ARE NOT ELIGIBLE FOR PA 40 SCHEDULE SP, YOU ARE NOT ELIGIBLE FOR
INCOME-BASED TAXATION AND ARE NOT ELIGIBLE FOR LINES 3-4 OR LINES 8-9.
    1.  Pro Rata Resident taxable income/loss   NOT eligible   for Income Based Rate
         from Page 2, Worksheet A, Line 5...................................................................................................................... 1.   X 9999999
    2.  Line 1 X .038809.    If Line 1 is a loss, enter "0"...............................................................................................      2.     9999999
    3.  Pro Rata Resident taxable income/loss   eligible   for Income Based Rate
         from Page 2, Worksheet A, Line 6.....................................................................................................................  3.   X 9999999
    4.  Line 3 X .033809.    If Line 3 is a loss, enter "0"................................................................................................     4.     9999999
    5.  Total Resident Tax Due  (Line 2 plus Line 4)......................................................................................................      5.     9999999
    6.  Pro Rata Non-Resident taxable income/loss   NOT eligible for Income Based Rate
         from Page 2, Worksheet B, Line 7.....................................................................................................................  6.   X 9999999
    7.  Line 6 X .034567.    If Line 6 is a loss, enter "0"................................................................................................     7.     9999999
    8.  Pro Rata Non-Resident taxable income/loss   eligible for Income Based Rate
         from Page 2, Worksheet B, Line 8.....................................................................................................................  8.   X 9999999
    9.  Line 8 X .029567.    If Line 8 is a loss, enter "0"................................................................................................     9.     9999999
   10.  Total Non-Resident Tax Due  (Line 7 plus Line 9).............................................................................................           10.    9999999

   11.  Total Tax Due (Line 5 plus Line 10)..................................................................................................................   11.    9999999

 12a.  60% BIRT credit from Page 3, Worksheet K, Line 4 or Worksheet D, Line 8...................................................                               12a.   9999999
 12b.  Estimated payments and other credits from Page 3, Worksheet E, Line 4......................................................                              12b.   9999999
 12c.  Total payments and credits.  (Line 12a plus Line 12b).....................................................................................               12c.   9999999

  13.  Net Tax Due: (Line 11 less Line 12c.  If less than 0 enter the difference on Line 16)......................................... 13.                              9999999
  14.  Interest and Penalty.  Refer to web site for current percentage.........................................................................                 14.    9999999
  15.    TOTAL DUE including Interest and Penalty (Line 13 plus Line 14).
           Use payment coupon.  Make check payable to:  "City of Philadelphia"......................................................                            15.    9999999

 16.  Tax Overpaid.  If Line 12c is greater than Line 11, enter difference here............................................................                     16.    9999999
 17.  Enter 50% of Page 2, Worksheet C, Line 3.
        Do not use this line to remit estimated payments.........................................................................................               17.    9999999
 18.  Balance Available.  Line 16 minus Line 17.  If greater than 0 proceed to Overpayment Options................ 18.                                                 9999999
OVERPAYMENT OPTIONS  Only available if Line 18 is greater than 0.  Enter the amount to be:
19a.  Refunded.    Do not file a separate Refund Petition.......................................................................................                19a.   9999999
19b.  Applied, up to the tax due, to the 2018 Business Income & Receipts Tax Return............................................                                 19b.   9999999
19c.  Applied to the 2019 Net Profits Tax.................................................................................................................      19c.   9999999
           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 NPT Vendor 9-28-2018
                                                                         Page 1

- 33 -

WORKSHEETS A, B and C These are worksheets only.
2018 NET PROFITS TAX RETURN Do not file these worksheets with your return.

Instructions for Worksheets A and B
Enter on Line 1 the net income or loss from the appropriate Federal Tax return(s) or if applicable, the Profit and Loss Statement.
Examples of Line 2 adjustments (not all inclusive): Federal Form 1040, Schedule "C" filers - add back to net income any taxes based on net income which
have been deducted in arriving at reported net income, e.g., prior year Net Profits Tax (the Business Income & Receipts Tax paid is deductible) .
Federal Form 1065 filers - add back to net income any taxes based on net income, capital gains, and guaranteed payments to partners; deduct from net
income IRC section 179 expense. Nonresidents may take an income exclusion for Public Law 86-272 activity.

WORKSHEET A: Business Income (Loss) for Residents

1. Net Income (Loss)................................................................................................................................. 1. .00

2. Federal Form 1065, Schedule K-1 and other adjustments..................................................................... 2. .00

3. Other taxable income............................................................................................................................ 3. .00

4. Taxable Resident Net Income (Loss). Add Lines 1 through 3.............................................................. 4. .00
5. Taxable Pro Rata Resident portion of Net Income/Loss NOT eligible for Income-based rate.
Enter here and on Page 1, Line 1......................................................................................................... 5. .00
6. Taxable Pro Rata Resident portion of Net Income/Loss eligible for Income-based rate.
Enter here and on Page 1, Line 3......................................................................................................... 6. .00

WORKSHEET B: Business Income (Loss) for Nonresidents
Nonresidents of Philadelphia may apportion all or part of their net income to their places of business located outside of Philadelphia on Line 5, using
Worksheet NR-3 on Page 4. The apportionment is based on a three factor formula consisting of an average of the property owned, the salaries and
wages paid, and the receipts earned during the tax year.
1. Net Income (Loss)................................................................................................................................ 1. .00

2. Federal Form 1065, Schedule K-1 and other adjustments................................................................... 2. .00

3. Other taxable income........................................................................................................................... 3. .00

4. Total Net Income (Loss). Add Lines 1 through 3................................................................................ 4. .00

5. Philadelphia apportionment factor from Page 4, Worksheet NR-3, Line 12.......................................... 5. .

6. Taxable Nonresident Net Income (Loss). (Line 4 times Line 5)............................................................ 6. .00
7. Taxable Pro Rata Nonresident portion of Net Income/Loss NOT eligible for Income-based rate.
Enter here and on Page 1, Line 6......................................................................................................... 7. .00
8. Taxable Pro Rata Nonresident portion of Net Income/Loss eligible for Income-based rate.
Enter here and on Page 1, Line 8......................................................................................................... 8. .00

WORKSHEET C: Computation of Estimated Tax Base
If the amount on Line 3 is $100 or less, estimated payments are not required. If the amount on Line 3 is greater than $100, enter 25% of the amount on
the first and second estimated coupon. If Net Profits Tax estimated payments are required, there are two payments due. The first estimated tax payment
is due April 15, 2019 and the second estimated tax payment is due June 17, 2019. Estimated tax payments are not required on September 15, 2019
or January 15, 2020.

1. Net Profits Tax Liability from Page 1, Line 11........................................................................................ 1. .00

2. Business Income & Receipts Tax Credit from Page 1, Line 12a or Page 3, Worksheet D, Line 8......... 2. .00
3. Estimated Payments Base (Line 1 minus Line 2)
If Line 2 is greater than Line 1, no Estimate coupon is needed............................................................. 3. .00

2018 NPT Worksheets P2 9-19-2018
Page 2

- 34 -

WORKSHEETS D, E, K and EXTENSION These are worksheets only.
2018 NET PROFITS TAX RETURN Do not file these worksheets with your return.

WORKSHEET D: ALLOCATION OF BUSINESS INCOME & RECEIPTS TAX CREDIT FOR PARTNERSHIPS, ETC., WITH
CORPORATE MEMBERS (THIS SCHEDULE IS TO BE USED ONLY BY PARTNERSHIPS, JOINT VENTURES AND ASSOCIATIONS
WHICH ARE COMPOSED OF ONE OR MORE CORPORATE PARTNERS, CORPORATE JOINT VENTURES, OR CORPORATE
ASSOCIATES.)

1. Enter the portion of taxable income on which 2018 Business Income & Receipts Tax has been paid,
AND which represents the distributive shares of net income of ALL CORPORATE MEMBERS........... 1. .00

2. Enter the total taxable income of the taxpayer on which 2018 BIRT has been paid............................... 2. .00

3. Divide Line 1 by Line 2 and enter the percentage here and on Page 1 of the return............................... 3. %

4. Enter the amount from Worksheet K, Line 2.......................................................................................... 4. .00

5. Multiply the amount on Line 4 by the percentage on Line 3.................................................................... 5. .00

6. Subtract Line 5 from Line 4................................................................................................................... 6. .00

7. Enter the amount from Page 1, Line 11................................................................................................. 7. .00
8. Business Income & Receipts Tax Credit allowed. Enter the lesser of Line 6 or Line 7 here and on
Page 1, Line 12a................................................................................................................................... 8. .00

WORKSHEET E: Summary of Payments and Other Credits

1. 2018 Estimated Net Profits Tax Payments.............................................................................................. 1. .00

2. Payments of 2018 Net Profits Tax made with Application for Extension of Time to File.................... 2. .00
3. Overpayment of 2018 Business Income & Receipts Tax or 2017 Net Profits Tax
to be applied to this return............................................................................................................... 3. .00

4. TOTAL of Lines 1 through 3. Enter here and on Page 1, Line 12b......................................................... 4. .00

WORKSHEET K: 60% Business Income and Receipts Tax Credit
1. Enter the amount from Page 1, Line 1 of the 2018 Business Income & Receipts Tax or
BIRT-EZ return.................................................................................................................................... 1. .00
2. Enter 60% of the amount on Line 1. If your entity has corporate members, STOP HERE and
enter this amount on Worksheet D, Line 4.............................................................................................. 2. .00

3. Enter the amount from Page 1, Line 11 of the 2018 Net Profits Tax return............................................. 3. .00
4. Business Income & Receipts Tax credit allowed. Enter the lesser of Line 2 or Line 3 here and
on Page 1, Line 12a............................................................................................................................... 4. .00

EXTENSION WORKSHEET
This is an extension worksheet to be used when figuring the amount of Net Profits tax you owe. You must file an actual return by the extension due date
to satisfy your filing requirements. If an extension of time has been obtained from the Internal Revenue Service for filing your corporate, partnership or
individual tax returns, the corresponding returns are due on or before the due date of the federal extension(s). You must pay 100% of the estimated
tax due by April 15, 2019. Filing an extension coupon does not extend the time to pay the tax. Interest and penalty shall be added to the amount
of tax not paid by the statutory due date. You will not receive written confirmation of your extension request. NOTE: If you have filed for an automatic
federal extension but do not believe you will owe any tax, you do not need to file an extension coupon.

1. 100% of estimated 2018 NET PROFITS tax due.................................................................................... 1. .00

2. Other payments and credits you expect to report on the NPT return...................................................... 2. .00
3. Tax Balance Due (Line 1 minus Line 2). Enter on the Extension Coupon.
If Line 2 is greater than Line 1, no extension coupon is needed............................................................. 3. .00

2018 NPT Worksheets P3 9-19-2018
Page 3

- 35 -

WORKSHEET NR-3 Computation of apportionment factors to be applied to apportionable
2018 NET PROFITS TAX RETURN net income of certain nonresidents of Philadelphia.

Calculation of Average Values of Real and Tangible Property Used in Business:
COLUMN A COLUMN B
PHILADELPHIA TOTAL EVERYWHERE

1. Inventories of Raw Materials, Work in Process and Finished Goods................... 1.

2. Land and Buildings Owned (at average original cost).......................................... 2.

3. Machinery and Equipment Owned (at average original cost)............................... 3.

4. Other Tangible Assets Owned (at average original cost)...................................... 4.

5. Rented Property (at 8 times the net annual rental)............................................... 5.

6. Total average value of Property used WITHIN PHILADELPHIA.......................... 6. XXXXXXXXXX

7. Total average value of Property used EVERYWHERE........................................ 7. XXXXXXXXXX

Computation of Apportionment Factors:
8A. Total average value of Philadelphia property from Column A, Line 6 above......................................... 8A. .00

8B. Total average value of property everywhere from Column B, Line 7 above......................................... 8B. .00

8C. Philadelphia property factor (Line 8A divided by Line 8B)................................................................... 8C. .

9A. Philadelphia Payroll............................................................................................................................ 9A. .00

9B. Payroll Everywhere............................................................................................................................. 9B. .00

9C. Philadelphia payroll factor (Line 9A divided by Line 9B)...................................................................... 9C. .

10A. Philadelphia receipts before BIRT Statutory Exclusion..................................................................... 10A. .00

10B. Gross receipts everywhere............................................................................................................... 10B. .00

10C. Philadelphia receipts factor (Line 10A divided by Line 10B)............................................................. 10C. .

11. TOTAL FACTORS (Total of Lines 8C, 9C and 10C)........................................................................... 11. .

12. Philadelphia apportionment factor (Line 11 divided by applicable number of factors)........................... 12. .
Enter factor here and on Page 2, Worksheet B, Line 5.

Allocation versus Apportionment of a Nonresident's Net Profits

A nonresident individual, partnership, association or other unincorporated entity conducting or carrying on any business, profession,
trade, enterprise or other activity is required to pay the Net Profits Tax (NPT) on the entire net profits of the business if activityall is
conducted within the City of Philadelphia. This is true despite the absence of a Philadelphia office or business location.

Where a nonresident maintains both Philadelphia and non-Philadelphia branch offices, the taxpayer may allocate net profits between or
among the Philadelphia and non-Philadelphia branch locations. The taxpayer must be prepared to show the Revenue Department that
each branch office or location is self-sustaining and established. This is a question of fact, depending on the particular circumstances in
each case. One factor (of many) used by the Department to support a branch office is the presence of separate branch accounting
books and records to support the allocation of the net profits between or among the various branch offices. In the absence of separate
accounting records, the nonresident taxpayer must apportion their net profits using the three-factor apportionment formula. Refer to
Income Tax Regulation 222 at www.phila.gov/revenue.

2018 NPT Worksheets P4 9-19-2018
Page 4

- 36 -

         Philadelphia Scan Line Data 
 
         2018 Net Profit Payment Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  03
 
 6 – 11  Due Date - 041519 
 
 12 – 19 Zero filled 
 
 20 – 26 Business Tax Account Number 
 
 27 – 49 Zero filled 
 
 50 – 53 Period / Year - 1218 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 37 -

         Philadelphia Scan Line Data 
 
         2018 Net Profit Extension Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  03
 
 6 – 11  Due Date - 041519 
 
 12 – 19 Zero filled 
 
 20 – 26 Business Tax Account Number 
 
 27 – 49 Zero filled 
 
 50 – 53 Period / Year – 1318 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 38 -

                                       Detachhere
 ----------------------------------------------------------------------------------------------------------------------------------------------- 
                                                    
                  2018 NET PROFITS TAX                                     Due Date April 15, 2019 
 EXTENSION PAYMENT COUPON 
 
                  Name and address                                                     
 TAXPAYER NAME 
 and ADDRESS      Name and address                                                     
                  Name and address                                                     
 CITY ACCOUNT #:  1234567                                                              
                                                                                       
                                                     (1) Estimated Tax Due              9999999     .00 
 
                            Make check payable to:  "City of Philadelphia" 
                            Include your Account Number on your check or money order. 
 
 33303041519000000001234567000000000000000000000001318000000000000009 
 
                                       Detach here 
 ----------------------------------------------------------------------------------------------------------------------------------------------- 
                                                    
 2018 NET PROFITS TAX                                                      Due Date April 15, 2019 
             PAYMENT COUPON 
                                                                                                    
 TAXPAYER NAME    Name and address                                                                  
 and ADDRESS      Name and address                                                                  
                                                                                                    
                  Name and address                                                                  
 CITY ACCOUNT #:  1234567               
                                                                                                    
                                                   (1) Total Due from Page 1, Line 15   9999999     .00 
 
                            Make check payable to:  "City of Philadelphia" 
                            Include your Account Number on your check or money order. 
 
 33303041519000000001234567000000000000000000000001218000000000000001

- 39 -

         Philadelphia Scan Line Data 
 
         2018 Net Profit - 1st Estimate Payment Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  03
 
 6 – 11  Due Date - 041519 
 
 12 – 19 Zero filled 
 
 20 – 26 Business Tax Account Number 
 
 27 – 49 Zero filled 
 
 50 – 53 Period / Year - 0119 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 40 -

         Philadelphia Scan Line Data 
 
         2018 Net Profit - 2nd Estimate Payment Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  03
 
 6 – 11  Due Date - 061519 
 
 12 – 19 Zero filled 
 
 20 – 26 Business Tax Account Number 
 
 27 – 49 Zero filled 
 
 50 – 53 Period / Year - 0219 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 41 -

                                 Detach here 
---------------------------------------------------------------------------------------------------------------------------------------------- 
            2019 NET PROFITS TAX                                       Due Date: April 15, 2019 
    1st ESTIMATED PAYMENT COUPON 

TAXPAYER NAME   Name and address 
and ADDRESS     Name and address             (1) Enter 25% of amount from           7777777     .00 
                                                 Worksheet C, Line 3
                Name and address 
CITY ACCOUNT #:                                                                                 .00 
                1234567                      (2) TaxfromOverpaidNPT Page 1, Line 16 7777777 
                                             (3) First estimate of 2018 NPT         7777777     .00 
                                                 (Line 1 minus Line 2) 

                         Make check payable to: "City of Philadelphia" 
                         Include your Account Number on your check or money order. 

    33303041519000000001234567000000000000000000000000119000000000000002 

                                 Detachhere
----------------------------------------------------------------------------------------------------------------------------------------------
            2019 NET PROFITS TAX                                       Due Date June 15, 2019
    2nd ESTIMATED PAYMENT COUPON 

TAXPAYER NAME   Name and address 
and ADDRESS     Name and address             (1) Enter 25% of amount from           7777777     .00 
                                                 Worksheet C, Line 3 
                Name and address 
CITY ACCOUNT #: 1234567                      (2) Tax Overpaid                       7777777     .00 
                                                 from from ENP-1 
                                             (3) Second estimate of 201 9NPT        7777777     .00 
                                                 (Line 1 minus Line 2) 

                         Make check payable to: "City of Philadelphia" 
                         Include your Account Number on your check or money order. 

    33303061519000000001234567000000000000000000000000219000000000000001

- 42 -

                  2018 Annual Reconciliation of Employer Wage Tax 
   
                                       Form Barcode Number: 1218 
                                       Barcode Type: Code 3 of 9 
                                    
   Top Barcode X/Y Position:           40/4       Bottom Barcode X/Y Position:            57/63 
   Top Barcode Narrow Bar Width:       15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
   Top Barcode Narrow to Width Ratio:  2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
            Field                              # of chars.        X/Y Start Position 
                                                                  
    Top Left Reg. Mark                                            6/4 
    Top Right Reg. Mark                                           79/4 
    Bottom Left Reg. Mark                                         6/61 
    Bottom Right Reg. Mark                                        79/61 
                                                                  
    Name & Address Line 1                      40                 7/9 to 46/9 
    Name & Address Line 2                      40                 7/10 to 46/10 
    Name & Address Line 3                      40                 7/11 to 46/11 
    Name & Address Line 4                      40                 7/12 to 46/12 
    Name & Address Line 5                      40                 7/13 to 46/13 
                                                                  
    City Account Number                        7                  62/7 to 68/7 
    Federal Identification Number              9                  61/10 to 70/10 
    Termination Date                           10                 61/14 to 70/14 
    Amended Return Check Box                   1                  78/16 to 78/16 
                                                                  
    Line A                                     5                  74/18 to 78/18 
    Line B                                     5                  74/20 to 78/20 
    Line C                                     5                  74/22 to 78/22 
    Line D                                     5                  74/24 to 78/24 
                                                                  
    Line 1                                     9                  70/26 to 78/26 
    Line 2                                     9                  70/28 to 78/28 
    Line 3                                     9                  70/30 to 78/30 
    Line 4                                     9                  70/32 to 78/32 
    Line 5                                     9                  70/34 to 78/34 
    Line 6                                     9                  70/36 to 78/36 
    Line 7                                     9                  70/38 to 78/38 
    Line 8                                     9                  70/40 to 78/40 
    Line 9                                     9                  70/42 to 78/42 
    Line 10                                    9                  70/44 to 78/44 
    Line 11                                    9                  70/46 to 78/46 
    Line 12                                    9                  70/48 to 78/48 
    Line 13                                    9                  70/50 to 78/50 
    Line 14                                    9                  70/52 to 78/52 
    Line 15                                    7                  72/54 to 78/54 
    Line 16                                    7                  72/56 to 78/56

- 43 -

DUE DATE: FEBRUARY 28, 2019
CITY OF PHILADELPHIA
ANNUAL RECONCILIATION OF 2018 City Account Number
EMPLOYER WAGE TAX 9999999

Name and address..................Line 1 Federal Identification Number
Name and address..................Line 2 999999999
Name and address..................Line 3
Name and address..................Line 4 If your business terminated in 2018, enter the
termination date AND file a CHANGE FORM.
Name and address..................Line 5
mm-dd-yyyy
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: X
A. Enter the number of Philadelphia Residents for whom wage tax was remitted for the pay period including
March 12, 2018....................................................................................................................................................A. 99999
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. 99999
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. 99999
D. Number of employees working at company locations within Philadelphia city limits,
for the pay period including March 12, 2018........................................................................................................D. 99999

1. Gross Compensation per W-2 forms for all employees.................................................................1. 999999999
2. Non-Taxable Gross Compensation included in Line 1.
(Paid to nonresidents working outside of Philadelphia).................................................................2. 999999999
3. Taxable income paid to employees earning tips on which City Wage Tax
was not withheld............................................................................................................................3. 999999999
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. 999999999
5. Taxable Gross Compensation paid to residents of Philadelphia
January 1, 2018 to June 30, 2018...............................................................................................5. 999999999

6. Tax Due (Line 5 times .038907)....................................................................................................6. 999999999
7. Taxable Gross Compensation paid to residents of Philadelphia
July 1, 2018 to December 31,2018.............................................. ...............................................7. 999999999

8. Tax Due (Line 7 times .038809)....................................................................................................8. 999999999
9. Taxable Gross Compensation paid to nonresidents of Philadelphia
January 1, 2018 to June 30, 2018...............................................................................................9. 999999999

10. Tax Due (Line 9 times .034654)...................................................................................................10. 999999999
11. Taxable Gross Compensation paid to nonresidents of Philadelphia
July 1, 2018 to December 31, 2018...........................................................................................11. 999999999

12. Tax Due (Line 11 times .034567)................................................................................................12. 999999999

13. Total Tax Due (Add Lines 6, 8, 10 and 12).................................................................................13. 999999999

14. Tax previously paid for 2018.....................................................................................................14. 999999999

15. ADDITIONAL TAX DUE If Line 13 is greater than Line 14, enter the amount here...................15. 9999999
16. TAX OVERPAID If Line 14 is greater than Line 13, enter the amount here.
See instructions............................................................................................................................16. 9999999
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 Vendor 9-28-2018

- 44 -

                   Philadelphia Scan Line Data 
 
          2018 Annual Wage Tax Reconciliation Coupon 
 
  Field #          Description 
 
  1 – 3            Always “333” 
 
  4 – 5            Type Tax -  01
 
  6 – 11           Due Date - 022819 
 
  12 – 19          Zero filled 
 
  20 – 26          Business Tax Account Number 
 
  27 – 49          Zero filled 
 
  50 – 53          Period / Year – see below 
 
  54 – 67          Zero filled 
 
  68               Check digit (“mod 10” routine) 
 
  Frequency        Period/year for scan line 
 
  Weekly filers         5318 
                       
  Monthly Filers        9118 
                       
  Semi-monthly filers   7818 
                       
  Quarterly filers      9618

- 45 -

                                 Detach here 
 ----------------------------------------------------------------------------------------------------------------------------------------------- 
                                              
         2018 ANNUAL RECONCILIATION OF                                    Due Date: February 28, 2019 

         WAGE TAX PAYMENT COUPON 
                                  
  NAME:  Quincy J. Taxpayer                                               Tax Due     7777777         .00 
                                  
  CITY AC COUNT #: 9999999                    Interest & Penalty                      7777777         .00 

                                                                          Total Due   7777777         .00 
 
                            Make check payable to: "City of Philadelphia" 
                            Include your Account Number on your check or money order. 
 
         33301022819000000009999999000000000000000000000005318000000000000008

- 46 -

               2018 ANNUAL RECONCILIATION OF EMPLOYER WAGE TAX

Who Must File:         All employers who paid taxable compensation to residents of Philadelphia, even if earned
                       outside of Philadelphia, and to non-residents for services performed within Philadelphia.

When To File:          The Annual Reconciliation of Employer Wage Tax for the calendar year 2018 is due on or
                       before February 28, 2019.  Failure to file and pay by this date will result in the
                       imposition of interest, penalty, fines and legal costs.

Where To File:         Sign the Annual Reconciliation return and mail to:  Philadelphia Department of Revenue,
                       P.O. Box 1670, Philadelphia, PA 19105-1670.

Print your numbers legibly to ensure efficient processing.  Photocopies of this return are not acceptable. Regulations, returns and instructions are
available at   www.phila.gov/revenue.  Contact the Department by calling 215-686-6600 or send e-mail to   revenue@phila.gov.
To file this return online, go to   ework.phila.gov/revenue.    After submitting the return you must print the resulting confirmation page for your
records.  W-2 data must be submitted in accordance with the requirements specified on Page 2 of these instructions.
If the entity no longer has wage tax withholding responsibilities, use the   Change Form to indicate the termination of wage tax liability and enter the
termination date on the return in the space provided. The Change Form is available online at   www.phila.gov/tax-change.  If the wage tax withholding
responsibilities terminated prior to 2018, mail in the Change Form but   do not complete and file a 2018 Wage Tax Reconciliation return.
Line 3:  Put on this line the amount of tip income reported to the employer by the tipped employees (e.g. IRS Form 4070) and any other tips allocated to
the employees (by the employer) in accordance with applicable U.S. Treasury Regulations.  An employer’s liability for withholding the Wage Tax on
employees’ tip income is based on the wages under the employer’s control (other than tips) and amounts turned over voluntarily to the employer by the
employee to meet the withholding.  Therefore if the employer is unable (due to insufficient funds) to withhold the Wage Tax on any compensation (i.e. both
salary and tips), report those amounts here.    
Line 13:  Tax Due - If the tax due on Line 13 of the Annual Reconciliation of Wage Tax return is $1 or more, make a check payable to "City of
Philadelphia".  Do not remit tax due if less than $1.  Internet filers can pay the tax due via credit card or by e-check.  A user fee is added when paying by
credit card.   E-CHECK IS FREE.
ACH Debits and Credits are accepted for payment of tax.  For more information or to enroll in this program go to   www.phila.gov/revenue/eft-ach   . Contact
the Electronic Government Unit at 215-686-6582, 6579 or 6628 or e-mail to   egovservices@phila.gov.
Returned Checks. If your check is returned unpaid for insufficient or uncollected funds, (1) you authorize The City of Philadelphia or its agent to make a
one-time electronic funds transfer from your account to collect a fee of $20; and (2) The City of Philadelphia or its agent may re-present your check
electronically to your depository institution for payment.

Line 16: Tax Overpaid - To obtain a refund of an overpayment of Philadelphia City Wage Tax, you must file a Refund Petition with the Department of
Revenue.  A refund can be the result of an over withholding of tax from the employees' pay by the employer or an overpayment of tax that was not withheld
(a duplicate payment).  If the overpayment is the result of over withholding, a letter signed by a company officer must accompany the Refund Petition
stating that the tax that was over withheld has been refunded to the employee(s) by the company.  If the refund is the result of a duplicate payment,
supporting documentation showing the duplicate payment must accompany your refund petition.
To download a Refund Petition, go to   www.phila.gov/documents/refund-petition-form.
If you have questions about your filing requirements, application of payments or tax balances due, call Taxpayer Services at 215-686-6600.

                                                          Interest, Penalties and Costs

       Effective January 1, 2014 - All taxes (except Real Estate) bear simple interest.  The annual rate shall be the
       Federal Short-Term Rate effective January 1 of such calendar year (26 § USCA 6621 et. seq.) plus five (5)
       percentage points.

       Penalty will be at the rate of 1¼% of the unpaid tax for each month or fraction thereof.

       For current interest rates, see the Department of Revenue's website at   www.phila.gov/revenue.

                                                                                                                       2018 Wage Inst.  9-19-2018
                                                                Page 1

- 47 -

W-2 Submission Requirements for 2018

Transmittal Form: The Annual Wage Tax Reconciliation return is the only form that is transmitted with the W2’s.
No other transmittal form is required.

Submitting W2s: Employers with more than 250 W2’s cannot remit on paper. Employers with less than 250
employees are strongly encouraged to remit electronic files and not use paper resources.

If you must submit W2’s electronically they must be submitted via our secure FTP site. Find instructions and access to
the FTP site at ework.phila.gov/revenue. The City will no longer accept CDs and other electronic media through the
mail.

After you successfully upload the W2 file, you will see instructions to send contact information to a City email
address. The email address is: w2.1099@phila.gov.

Online filing of the 2018 Annual Wage Tax Reconciliation return: If you file the 2018 Annual Wage Tax
Reconciliation return online, you must still prepare an electronic W2 file and submit it via the City’s secure FTP site.

Record Format for W2 electronic file: Only the EFW2 (formerly MMREF-1) format is acceptable. This is the same
format transmitted to the Social Security Administration, as stated in SSA Publication - Magnetic Media Reporting
and Electronic Filing for 2015. PDF files are not acceptable.

The RA, RE, RW and RS records must be included. It is extremely important to follow exactly all Social Security
Administration rules for displaying data. The following information must be included:

RE record:
Positions 222-248 – Employer Contact Name
Positions 249-263 – Employer Contact Phone Number
Positions 264-268 – Employer Contact Phone Extension
Positions 269-278 – Employer Contact Fax Number (If applicable enter the employers fax number
including area code. Otherwise fill with blanks)
Positions 279-318 – Employer Contact E-Mail/Internet

RS record: If the employer is withholding Philadelphia Wage Tax on the employee, then the following
positions are required (only include Philadelphia data - do not include data for other jurisdictions):
* “Tax Type Code” – This code must equal “C” (position 308).
* “Local Taxable Wages” – Positions 309 to 319 must equal Philadelphia Taxable Wages.
* “Local Income Tax Withheld” – Positions 320 to 330 must equal Philadelphia Wage Tax Withheld.
* “State Control Number” – Positions 331 to 337 must include the 7-digit City Tax Account number.

File name specifications: When you upload the electronic W2 file to the City’s website, please make sure that the
file name includes the name of your company, the 7-digit City Tax Account number, and the tax year.

Test Data: Philadelphia does not accept test data. If errors are found in your data file or if you have not used the
required EFW2 format, you will be contacted.

For inquiries concerning filing of W2’s, send an e-mail to revenue@phila.gov.

2018 Wage Inst. 9-19-2018
Page 2

- 48 -

                                        2018 Employee Earnings Tax 
   
                                        Form Barcode Number: 1318 
                                        Barcode Type: Code 3 of 9 
                                        
  Top Barcode X/Y Position:             40/4       Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:         15 mils    Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:    2.5        Bottom Barcode Narrow to Width Ratio:   2.5 
  
     Field                                      # of chars.         X/Y Start Position 
                                                                    
     Top Left Reg. Mark                                             6/4 
     Top Right Reg. Mark                                            79/4 
     Bottom Left Reg. Mark                                          6/61 
     Bottom Right Reg. Mark                                         79/61 
                                                                    
     Name & Address Line 1                      40                  7/9 to 46/9 
     Name & Address Line 2                      40                  7/10 to 46/10 
     Name & Address Line 3                      40                  7/11 to 46/11 
     Name & Address Line 4                      40                  7/12 to 46/12 
     Name & Address Line 5                      40                  7/13 to 46/13 
                                                                    
     Social Security Number                     9                   62/5 to 70/5 
     Termination Date                           10                  65/13 to 74/13 
     Amended Return Check Box                   1                   80/15 to 80/15 

     Line 1                                     7                   69/18 to 75/18 
     Line 2                                     7                   69/19 to 75/19 
     Line 3                                     7                   69/21 to 75/21 
     Line 4                                     7                   69/23 to 75/23 
     Line 5                                     7                   69/25 to 75/25 
     Line 6                                     7                   69/26 to 75/26 
     Line 7                                     7                   69/28 to 75/28 
     Line 8                                     7                   69/30 to 75/30 
     Line 9                                     7                   69/31 to 75/31 
     Line 10                                    7                   69/33 to 75/33 
     Line 11                                    7                   69/35 to 75/35 
     Line 12                                    7                   69/36 to 75/36 
     Line 13                                    7                   69/38 to 75/38 
     Line 14                                    7                   69/40 to 75/40 
     Line 15                                    7                   69/41 to 75/41 
     Line 16                                    7                   69/43 to 75/43 
     Line 17                                    7                   69/46 to 75/46 
     Line 18                                    7                   69/47 to 75/47 
     Line 19                                    7                   69/49 to 75/49 
     Line 20                                    7                   69/51 to 75/51 
     Line 21 A                                  7                   69/53 to 75/53 
     Line 21 B                                  7                   69/54 to 75/54

- 49 -

                   CITY OF PHILADELPHIA                                                                SOCIAL SECURITY NUMBER
            ANNUAL RECONCILIATION OF 2018                                                                                                                999999999
            EMPLOYEE EARNINGS TAX
                   DUE DATE APRIL 15, 2019
                                                                                           DO NOT FILE THIS RETURNif                                          tax was 100% withheld on
                                                                                           all compensation by your employer.  If tax was
Name and address..................Line 1                                                   overwithheld by your employer, file the Employee Wage
                                                                                           Tax Refund Petition available at   www.phila.gov/revenue
Name and address..................Line 2                                                   in the forms and documents section.
Name and address..................Line 3
                                                                                           Cancel this account by entering the termination date   
Name and address..................Line 4                                                   AND file a CHANGE FORM.
Name and address..................Line 5                                                                                                                      mm-dd-yyyy

YOU MUST USE THE CHANGE FORM TO REPORT A CHANGE OF ADDRESS.                                   If this is an amended return place an "X" here:                                          X
IF YOU ARE NOT ELIGIBLE FOR PA 40 SCHEDULE SP, YOU ARE NOT ELIGIBLE FOR
INCOME-BASED TAXATION AND CANNOT USE LINES 5, 8, 11, OR 14.
     1.  Gross Compensation received in 2018.  Enclose 2018 W-2 form(s)..........................................................                        1.       9999999
     2.  Non-taxable gross compensation from Page 2, Line 5..............................................................................                2.       9999999

    3.  Gross taxable compensation (Line 1 minus Line 2)...................................................................................              3.       9999999
         4.Taxable Gross Compensation received by a   resident of Philadelphia
         January 1, 2018 to June 30, 2018...........................................................................................................     4.       9999999
         5.Taxable Gross Compensation, eligible for Income-based Rate,
         received by a   resident of Philadelphia January 1, 2018 to June 30, 2018............................................                           5.       9999999
    6.  Tax Due (Line 4 times .038907   OR Line 5 times .033907 if claiming Income-based rate.)........................                                  6.       9999999
      7.    Taxable Gross Compensation received by a   resident of Philadelphia
         July 1, 2018 to December 31, 2018.........................................................................................................      7.       9999999
      8.    Taxable Gross Compensation, eligible for Income-based Rate,
         received by a   resident of Philadelphia July 1, 2018 to December 31, 2018.........................................                             8.       9999999
    9.  Tax Due (Line 7 times .038809 OR Line 8 times .033809 if claiming Income-based rate).........................                                    9.       9999999
    10.    Taxable Gross Compensation received by a   nonresident of Philadelphia
           January 1, 2018 to June 30, 2018.........................................................................................................     10.      9999999
  11.    Taxable Gross Compensation, eligible for Income-based Rate,
         received by a   nonresident of Philadelphia January 1, 2018 to June 30, 2018...................................                                 11.      9999999
    12.  Tax Due (Line 10 times .034654   OR Line 11 times .029654 if claiming Income-based rate)....................                                    12.      9999999
  13.    Taxable Gross Compensation received by a   nonresident of Philadelphia
         July 1, 2018 to December 31, 2018.......................................................................................................        13.      9999999
  14.    Taxable Gross Compensation, eligible for Income-based Rate,
         received by a   nonresident of Philadelphia July 1, 2018 to December 31, 2018.................................                                  14.      9999999
  15.  Tax Due (Line 13 times .034567   OR Line 14 times .029567 if claiming Income-based rate).................... 15.                                           9999999

  16.  Total amount of Tax Due (Add Lines 6, 9, 12 and 15)..............................................................................                 16.      9999999
17.  Philadelphia Wage Tax withheld by employer or credit for taxes paid to local jurisdictions   
       outside of PA. Attach W-2. See Instructions
         If Line 17 is greater than Line 16 file an Employee Wage Tax Petition for this amount....................                                       17.      9999999
 18.  Tax balance due.  (Line 16 minus Line 17.  Cannot be less than zero.)....................................................                          18.      9999999

 19.  Tax that   you,   not your employer, previously paid for 2018. (Not included on W-2 forms)......................... 19.                                     9999999
  20.    TAX DUE  If Line 18 is greater than Line 19,  enter here and in the Tax Due box   
         of the Payment Coupon.......................................................................................................................... 20.      9999999
21a.  If Line 18 is less than Line 19, enter amount to be:   
         REFUNDED.   Do not file a separate Refund Petition. Enclose W-2 forms.........................................                                  21a.     9999999
21b.  Amount of overpayment to be   APPLIED to the 2019 Earnings Tax Return...........................................                                   21b.     9999999
            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 Earnings Vendor 9-28-2018
                                                                  Page 1

- 50 -

                                            NON-RESIDENT EMPLOYEE EARNINGS ALLOCATION
                                   AND/OR DEDUCTIBLE EMPLOYEE BUSINESS EXPENSES REPORT

Residents and non-residents of Philadelphia must complete this report to calculate deductible employee business
expenses.  Certain non-residents must complete this report to calculate non-taxable compensation.    If wage tax was
overwithheld by your employer, do not file this return.  File the Employee Wage Tax Refund Petition.

EMPLOYER                                                                                                        EMPLOYEE SOCIAL SECURITY NUMBER

PLACE OF EMPLOYMENT                                                                                             IF PARTIAL YEAR, PROVIDE DATES:
                                                                                                                From                                           To
                                                                                                                EMPLOYER IDENTIFICATION NUMBER (From Form W-2)

                                                                                                                Column A                                         Column B
      Read Instruction Sheets A and B before completing this report.                                            1/1/2018 to 6/30/2018          7/1/2018 to 12/31/2018
1.    GROSS COMPENSATION FOR EMPLOYEES PAID ON A SALARY BASIS per FORM W-2                                                            .00                                .00

     A.  Non-Taxable Compensation (e.g. Stock Options) included in Line 1.  (Must reflect on W-2)                                     .00                                .00

     B.  Adjusted Gross Compensation  (Subtract Line 1A from Line 1)                                                                  .00                                .00
2.  Computation of taxable compensation and/or allowable expenses
     A.  Number of Days/Hours  (Include overtime from Line 2C)                                                  Days/Hours                                          Days/Hours
     B.  Non-workdays/Hours  (Total of weekend, vacation, holiday, sick or any type of leave time)              Days/Hours                                          Days/Hours
     C.  Number of actual Workdays/Hours  (Base_______________Overtime_______________)
           (Line 2A minus Line 2B)                                                                              Days/Hours                                          Days/Hours

     D.  Number of actual Days/Hours worked outside of Philadelphia in Line 2C                                  Days/Hours                                          Days/Hours
     E.  Percentage of time worked outside of Philadelphia  (Line 2D divided by Line 2C)                                              %                                  %

     F.  Non-taxable gross compensation earned outside of Philadelphia  (Line 1B times Line 2E)                                       .00                                .00

G. (i)  Total non-reimbursed business expenses pursuant to Income Tax Regulations Section 204                                         .00                                .00
         (ii)  Multiply amount on Line 2G (i) by the percentage on Line 2E                                                            .00                                .00

         (iii)  Deductible non-reimbursed employee business expenses.  (Subtract Line 2G (ii) from Line 2G (i))                       .00                                .00

     H.  Non-taxable income and/or deductible employee business expenses  (Add Line 2F and Line 2G (iii))                             .00                                .00

3.    GROSS COMPENSATION FOR EMPLOYEES PAID ON A COMMISSION BASIS per FORM W-2                                                        .00                                .00

     A.  Non-Taxable Compensation (e.g. Stock Options) included in Line 3.  (Must reflect on W-2)                                     .00                                .00
     B.  Adjusted Gross Compensation  (Subtract Line 3A from Line 3)                                                                  .00                                .00
4.  Computation of taxable compensation and/or allowable expenses
     A.  Total Sales                                                                                                                  .00                                .00

     B.  Sales earned outside of Philadelphia (Income Regulations 209(b))                                                             .00                                .00
     C.  Percentage of sales outside of Philadelphia.  (Divide Line 4B by Line 4A.)                                                   %                                  %

     D.  Commissions earned outside of Philadelphia.  (Multiply Line 3B by 4C.)                                                       .00                                .00

E. (i)  Total non-reimbursed business expenses pursuant to Income Tax Regulations Section 204                                         .00                                .00

         (ii)  Multiply amount on Line 4E (i) by the percentage on Line 4C                                                            .00                                .00
         (iii)  Deductible non-reimbursed employee business expenses.  (Subtract Line 4E (ii) from Line 4E (i))                       .00                                .00
F.  Non-taxable gross commissions/deductible employee business expenses. (Add Line 4D and Line 4E (iii))                              .00                                .00

5.    TOTAL NON-TAXABLE GROSS COMPENSATION  (Add Lines 2H and Line 4F from Columns A   and B.)                                                                   .00
     Enter here and on Line 2 of the return.
6.    TAXABLE GROSS COMPENSATION (Line 1B minus Line 2H   PLUS Line 3B minus Line 4F)
     Residents enter Column A on Page 1, Line 4 or 5; Non-residents enter Column A on Page 1, Line 10 or 11.                          .00                                .00
     Residents enter Column B on Page 1, Line 7 or 8; Non-residents enter Column B on Page 1, Line 13 or 14.

                                                                                                                                          2018 Earnings P2  9-19-2018
                                                                                    Page 2

- 51 -

ANNUAL RECONCILIATION OF EMPLOYEE EARNINGS TAX INSTRUCTIONS

Residents of Philadelphia who received compensation and wage tax was not deducted on gross compensation and Nonresidents who
have received compensation for services performed in Philadelphia and wage tax was not deducted on that compensation must file
this return. Gross compensation includes wages, commissions, tips, bonuses, severence pay, sick and/or vacation pay, non-cash
compensation, and military reserve pay excluding active duty. EmployeePension plan contributions (such as 401k contributions)
are subject to wage tax and are not deductible from gross compensation.

Eligibility for Reduced Rate and PA 40 Schedule SP – To receive a decreased Resident or Nonresident Rate, you must file Schedule
SP with the state and be approved. Generally, to be eligible under Schedule SP, you must meet the following income requirements
based on your marital and federal filing status, number of dependents and income. Include SP Schedule with filing.

SCHEDULE SP ELIGIBILITY INCOME TABLE
Number of Unmarried, Separated Married
Dependent Children and Deceased (Even if filing separately)
0 $8,750 $15,250
1 $18,250 $24,750
2 $27,750 $34,250
3 $37,250 $43,750
4 $46,750 $53,250
5 $56,250 $62,750
6 $65,750 $72,250
7 $75,250 $81,750
8 $84,750 $91,250
9 $94,250 $100,750

The Annual Reconciliation of Employee Earnings Tax for 2018 is due on or before April 15, 2019. Failure to file and pay by this date
will result in the imposition of interest and penalty. Sign the return, enclose W-2 forms, PA Schedule SP (if applicable) and mail to:
Philadelphia Department of Revenue, P.O. Box 1648, Philadelphia, PA 19105-1648.

If the tax due on Line 20 of the return is $1 or more, make a check payable to "City of Philadelphia". Include the last 4 digits of your
Social Security Number on your check or money order. If your check is returned unpaid for insufficient or uncollected funds, (1) you
authorize The City of Philadelphia or its agent to make a one-time electronic funds transfer from your account to collect a fee of $20; and
(2) The City of Philadelphia or its agent may re-present your check electronically to your depository institution for payment.

ACH Debits and Credits are accepted for payment of tax. For more information or to enroll in this program go to www.phila.gov/eft-ach.
Contact the Electronic Government Unit at 215-686-6582, 6479 or 6628 or e-mail to egovservices@phila.gov.

If wage tax was overwithheld by your employer, do not file this return. File the Employee Wage Tax Refund Petition.
To download a Refund Petition, go to www.phila.gov/revenue in the "Tax Forms & Instructions" section.

IF LINE 17 OF THE RETURN IS GREATER THAN LINE 16 (100% EMPLOYER WITHHELD), DO NOT FILE THIS RETURN.
COMPLETE A CHANGE FORM TO CANCEL YOUR ACCOUNT.

Do not staple the tax return. Do not submit photocopies of this return. Complete and submit a Change Form to report a mailing address
change or to cancel your account.

If you have questions about this return call 215-686-6600 or send an e-mail to revenue@phila.gov. Additional tax returns, instructions,
refund petitions and the Change Form can be downloaded at www.phila.gov/revenue and require Adobe Acrobat Reader.

Interest, Penalties and Costs
Effective January 1, 2014 - All taxes (except Real Estate) bear simple interest. The annual rate shall be the Federal
Short-Term Rate effective January 1 of such calendar year (26 § USCA 6621 et. seq.) plus five (5) percentage points.

Penalty will be at the rate of 1¼% of the unpaid tax for each month or fraction thereof.

For current interest rates, see the Department of Revenue's website at www.phila.gov/revenue.

2018 Earnings Inst. 9-21-2018
Instruction Sheet A

- 52 -

NON-RESIDENT EMPLOYEE EARNINGS ALLOCATION
AND/OR DEDUCTIBLE EMPLOYEE BUSINESS EXPENSES REPORT INSTRUCTIONS

If Wage tax was overwithheld by your employer, do not file this return. File the Employee Wage Tax Refund Petition.

Allocated Compensation: A nonresident of Philadelphia receiving compensation for services performed both in and
out of Philadelphia may allocate that compensation by completing Page 2 of the Annual Reconciliation of Earnings Tax
Return.

You must enclose copies of your W-2 forms containing Federal, Medicare, State and Local Wages. If you worked a partial
year in Philadelphia, fill in the beginning and ending dates. Page 2, Line 2A should only reflect the number of days/hours
employed.

Line 2B - Non-workdays/Hours: During a period of sickness or disability, if you receive your regular salary, the salary is
considered to be taxable compensation. If you receive worker's compensation or a plan in lieu of worker's compensation
where the amount received is less than your regular salary, the compensation is not subject to Philadelphia Wage Tax.
Non-workdays include Saturday, Sunday, vacation, holidays, leave, sick days, and any day you do not actually
work. Include 104 days for Saturday and Sunday if you work a 5 day week.

Line 2C: If computing overtime, fill in hours and include overtime hours in Line 2A.

Line 2G/4E - Expenses: Entries on Lines 2G and 4E must be supported by Federal Form 2106. If unreimbursed
employee expenses are claimed on Federal Schedule A, you must also include Schedule A. Photocopies are acceptable.
Expenses are deductible if the total expenses are reduced by any amounts reimbursed by your employer and they are
ordinary, necessary and reasonable.

Examples of expenses which are not deductible are: transportation to and from work, certain educational expenses,
dues, subscriptions, and pension plan contributions. You must be a Statutory Employee as indicated on your W-2 form
to claim Federal Schedule C expenses. Otherwise, you must obtain a Philadelphia Business Tax Account Number and
file Business Income & Receipts/Net Profits Tax returns. If you are not a Statutory Employee and you want to claim
Federal Schedule C expenses, do not file the Earnings Tax Reconciliation return. To obtain a Business Tax Account
Number application, refer to the contact information on Instruction Sheet A.

Line 5 - Total Non-taxable Gross Compensation: Enter the total of Line 5 on Page 1, Line 2.

Line 6 - Taxable Gross Compensation: Residents enter Column A on Page 1, Line 4 or Line 5 if eligible for
Income-based rate; Column B on Page 1, Line 7 or Line 8 if eligible for Income-based rate. Nonresidents enter
Column A on Page 1, Line 10 or Line 11 if eligible for Income-based rate; Column B on Page 1, Line 13 or Line 14
if eligible for Income-based rate.
Wage Taxes Paid or Payable to Other Jurisdictions Within Pennsylvania

Residents of Philadelphia are required to pay Philadelphia Wage Tax on all salaries, wages and compensation regardless
of where that compensation was earned. Philadelphia residents employed in other localities in Pennsylvania should
instruct their employers not to withhold other local income taxes from their compensation.

Nonresidents of Philadelphia residing in Pennsylvania and employed within the City of Philadelphia must pay the
Philadelphia Wage tax on all compensation earned in Philadelphia. Nonresident compensation not subject to Philadelphia
Wage Tax (due to services rendered outside of Philadelphia) may be subject to taxation in the employee's home
jurisdiction.
Wage Taxes Paid or Payable to Other Jurisdictions Outside Of Pennsylvania

Residents of Philadelphia whose wages are subject to the taxes of local jurisdictions outside of Pennslyvania, can take a
credit against the Earnings Tax due on line 17 of page 1 of the Earnings Tax Return. Include a copy of the W-2 showing the
tax paid to the other jurisdiction.

Reciprocal Agreements
(Employment in/or Residents of States other than Pennsylvania)

The City of Philadelphia is not a party to any reciprocal tax agreements with any other state or political subdivision thereof.
Nonresidents of Pennsylvania cannot claim a tax credit against Philadelphia Wage Tax for income taxes paid to any other
state or political subdivision. Residents of Philadelphia employed outside of Pennsylvania may be required to file and pay a
local income tax in that jurisdiction in addition to Philadelphia Wage Tax.
2018 Earnings Inst. 9-21-2018
Instruction Sheet B

- 53 -

            Philadelphia Scan Line Data 
 
         2018 Earnings Tax Reconciliation Coupon 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   02 
 
 6 – 11  Due Date - 041519 
 
 12 – 19 Zero filled 
 
 20 – 28 Social Security Number 
 
 29 – 49 Zero filled 
 
 50 – 53 Period / Year - 0518 
 
 54 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 54 -

                                       Detach here 
 ----------------------------------------------------------------------------------------------------------------------------------------------- 
                                                    
         2018 Annual Reconciliation of                                       Due Date:  April 15, 2019 
         Employee Earnings Tax Payment Coupon 
 
  NAME:  Chip Kelly                                                          Tax Due   7777777                        .00 
                                
  SOCIAL SECURITY #: 999999999                      Interest & Penalty                 7777777                        .00 

                                                                             Total Due 7777777                        .00 
 
                               Make check payable to: "City of Philadelphia" 
                               Include the last 4 digits of your Social Security Number on your check or money order. 
 
         33302041519000000009999999990000000000000000000000518000000000000007

- 55 -

                                      2018 School Income Tax 
   
                                      Form Barcode Number: 1518 
                                      Barcode Type: Code 3 of 9 
                                   
  Top Barcode X/Y Position:           40/4         Bottom Barcode X/Y Position:            57/63 
  Top Barcode Narrow Bar Width:       15 mils      Bottom Barcode Narrow Bar Width:        20 mils 
  Top Barcode Narrow to Width Ratio:  2.5          Bottom Barcode Narrow to Width Ratio:   2.5 
  
     Field                             # of chars.              X/Y Start Position 
                                                             
     Top Left Reg. Mark                                         6/4 
     Top Right Reg. Mark                                        79/4 
     Bottom Left Reg. Mark                                      6/60 
     Bottom Right Reg. Mark                                     79/60 
                                                             
     Name & Address Line 1                    40                7/8 to 46/8 
     Name & Address Line 2                    40                7/9 to 46/9 
     Name & Address Line 3                    40                7/10 to 46/10 
     Name & Address Line 4                    40                7/11 to 46/11 
     Name & Address Line 5                    40                7/12 to 46/12 
                                                             
     Social Security Number                   9                 60/8 to 68/8 
     Spouse's SS#                             9                 60/11 to 68/11 
     Amended Return Check Box                 1                 79/13 to 79/13 
     Partial Resident Date 1                  10                56/15 to 65/15 
     Partial Resident Date 2                  10                70/15 to 79/15 
     Termination Date                         10                70/16 to 79/16 
                                                             
     Line 1                                   7                 70/18 to 76/18 
     Line 2                                   7                 70/20 to 76/20 
     Line 3                                   7                 70/22 to 76/22 
     Line 4                                   7                 70/24 to 76/24 
     Line 5                                   7                 70/26 to 76/26 
     Line 6                                   7                 70/28 to 76/28 
     Line 7                                   7                 70/30 to 76/30 
     Line 8                                   7                 70/32 to 76/32 
     Line 9                                   7                 70/34 to 76/34 
     Line 10                                  7                 70/36 to 76/36 
     Line 11                                  7                 70/38 to 76/38 
     Line 12                                  7                 70/40 to 76/40 
     Line 13                                  7                 70/42 to 76/42 
     Line 14                                  7                 70/44 to 76/44 
     Line 15 A                                7                 70/47 to 76/47 
     Line 15 B                                7                 70/49 to 76/49

- 56 -

          CITY OF PHILADELPHIA                                                               DUE DATE:  APRIL 15, 2019
          2018 SCHOOL INCOME TAX
                                                                                             Your Social Security Number
Name and address..................Line 1                                                            999999999
Name and address..................Line 2
                                                                                            Spouse's Social Security Number
Name and address..................Line 3
Name and address..................Line 4                                                            999999999
Name and address..................Line 5
DO NOT REPORT NEGATIVE NUMBERS ON THIS RETURN                                   If this is an amended return place an "X" here.                      X
YOU MUST USE THE CHANGE FORM TO REPORT A CHANGE OF ADDRESS.
If you were a partial year resident in 2018, see instructions and enter dates of residency:  mm-dd-yyyy                                    to mm-dd-yyyy
If you no longer have income subject to School Income Tax enter the termination date   AND   file a CHANGE FORM.                              mm-dd-yyyy

   1.  Net Taxable Dividends (School Income Tax Regulation 203(a))...............................................1.                           9999999

   2.  Taxable Interest (Reg. 203(b))...................................................................................................2.    9999999

   3.  "Subchapter S" Corporation Income Distribution (Regs. 202 and 203)......................................3.                             9999999

   4.  Limited Partnership Income (Reg. 203(i)).  If loss, enter "0" (zero)............................................4.                     9999999

   5.  Taxable Income received by a Beneficiary of an Estate or Trust (Reg. 205).............................5.                               9999999

   6.  Net Short Term Capital Gains   (held 6 months or less)    If loss, enter "0" (zero)......................6.                            9999999

   7.  Net Rental Income (Reg. 203(c)).  If loss, enter "0" (zero).........................................................7.                 9999999

   8.  Other Taxable Income (Reg. 203(e, f, g and h)).........................................................................8.              9999999

   9.  Total Taxable Income (Add lines 1 through 8)............................................................................9.             9999999

   10.  Deductible Expenses   (cannot exceed Line 9)   (Reg. 204(a))..................................................10.                     9999999

   11.  Net Taxable Income (Subtract line 10 from line 9)....................................................................11.              9999999

   12.  Gross Tax Due (Multiply line 11 by .038809)............................................................................12.            9999999

   13.  Credit from overpayment of prior year or tax previously paid by extension..............................13.                            9999999

   14.    TAX DUE  If Line 12 is greater than Line 13, enter the difference here ...................................14.                       9999999

OVERPAYMENT OPTIONS  If Line 12 is less than Line 13, enter the amount to be:
     15A.  Refunded.  Do not file a separate Refund Petition...........................................................15A.                   9999999

   15B.  Applied to the 2019 School Income Tax...............................................................................15B.             9999999

          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 #_________________________

Spouse's Signature________________________________________ Date_______________________Phone #_________________________

Preparer Signature_________________________________________ Date_______________________Phone #_________________________

   Sign the return and mail to:  Philadelphia Department of Revenue, P.O. Box 389, Philadelphia, PA 19105-0389

                                                                                                              2018 SIT Vendor 9-28-2018

- 57 -

2018 School Income Tax

S Corporation Shareholder
Worksheet to Calculate Regulatory Exclusion

(To be used by S Corporation Shareholders who reported their pro rata share of income from an S Corporation for Tax Years 2007 through 2013.)

Taxpayer Name Social Security Number

S Corporation Name Employer ID Number

Calculation of Regulatory Exclusion for 2018 Net Taxable Distributions

Line 1. Distributions from AAA (from 2018 Federal 1120S Schedule K-1 - Line 16D)
Line 2. Pro rata S Corporation Income from 2018 Federal 1120S (If a loss enter zero).
Line 3. Difference (Line 1- Line 2)
* If Excess Distributions (Line 3 greater than 0) go to Line 4 to calculate the exclusion that can be taken.

**If Line 3 is less than or equal to 0 (i.e. negative number), report the distributions from Line 1 on Line 3 of the 2016 School
Income Tax return and do not complete the rest of this Worksheet.

Line 4. Exclusion Base Available (Total from, Line 7 of the 2015 Worksheet)
Line 5. 2018 Exclusion Allowed (Lower of Line 3 or Line 4)
Line 6. Net Taxable Distributions (Line 1 - Line 5)
***Report the Net Taxable Distributions from Line 6 on the 2018 School Income Tax return Line 3.

Line 7. Remaining Exclusion Base for 2019 SIT (Line 4 - Line 5)

Under the penalties of perjury, as set forth in 18 PA C.C. §§ 4902-4903 as amended, I swear that I have reviewed this worksheet and to the best
of my knowledge and belief, they are true and complete.

Taxpayer Signature :_____________ __________________________ Date:_____________ Phone No. _____________________

Spouse's Signature :_______________________________________ Date:_____________ Phone No. _____________________

Preparer Signature :_______________________________________ Date:______________Phone No. _____________________

2018 SIT Worksheet 9-19-2018

- 58 -

         Philadelphia Scan Line Data 
 
       2018 School Income Tax Payment and Extension Coupons 
 
 Field # Description 
 
 1 – 3   Always “333” 
 
 4 – 5   Type Tax -  29
 
 6 – 11  Due Date - 041519 
 
 12 – 18 Zero filled 
 
 19 – 27 Social Security Number 
 
 28 – 48 Zero filled 
 
 49 - 52 Period / Year - 1218 
 
 53 – 67 Zero filled 
 
 68      Check digit (“mod 10” routine)

- 59 -

                    SCHOOL INCOME TAX EXTENSION WORKSHEET 
 
 An automatic extension of time for filing the 2018 School Income Tax will be granted for 60 days (i.e., June 25, 2019) by 
 filing an extension payment coupon and paying 100% of the estimated tax due. If an extension of time to file has been 
 obtained from the Internal Revenue Service for filing your individual tax return, the corresponding School Income Tax 
 return is due on or before the due date of the federal extension. You will not receive a written confirmation of your 
 extension request. Filing the extension payment coupon does not extend the time to pay the tax. Interest and penalty 
 shall be added to the amount of tax not paid by the statutory due date. 
 
  1. Total Tax (100% of estimated tax due)...................................................................   7777777 .00 

  2. Other payments and/or credits you expect to report on Line 13.............................                 7777777 .00 
  
  3. Tax balance due (Line 1 minus Line 2)                                                                            
  Enter here and on the extension payment coupon.................................................               7777777 .00 
 
                    If Line 2 is greater than Line 1, do not file the extension coupon. 
 -------------------------------------------------------------------------------------------------------------------------------------------- 
                                                                            
        2018 SCHOOL INCOME TAX                                              Due Date:  April 15, 2019 
        PAYMENT COUPON 
 
 NAME:  FRODO BAGGINS                                                                             Tax Due       7777777 .00 
 
 SOCIAL SECURITY #: 999999999                                              Interest & Penalty                   7777777 .00 
                                                                                                                
                                                                            Total Due                           7777777 .00 
 
                              Make check payable to: "City of Philadelphia" 
                              Include the last 4 digits of your Social Security Number on your check or money order. 
 
        33329041519000000099999999900000000000000000000012180000000000000002 
 
 -------------------------------------------------------------------------------------------------------------------------------------------- 
                                                                          
        2018 SCHOOL INCOME TAX                                              Due Date:  April 15, 2019 
        EXTENSION PAYMENT COUPON 
 
 NAME:  THORIN OAKENSHIELD 
 
 SOCIAL SECURITY #: 999999999               
                                            Extension Payment 
                                            (From Line 3 of the worksheet.)                                     7777777 .00 
 
                              Make check payable to: "City of Philadelphia" 
                              Include the last 4 digits of your Social Security Number on your check or money order. 
 
        33329041519000000099999999900000000000000000000012180000000000000002

- 60 -

                               2018 School Income Tax Return General Filing Information

The School District of Philadelphia imposes a tax on different classes of net income.  Examples of taxable income are dividends, certain interest, certain
rents, and royalties.  All residents of Philadelphia who receive these types of income must pay the tax.
Who should file -  Only Philadelphia residents with taxable income.  Review the instructions on Page 2 for a list of taxable income.
Interest on bank savings accounts, checking accounts and certificates of deposit issued by banks is not taxable.
If you were a resident of Philadelphia for only a portion of 2018, indicate your period of residency in the space provided on the return.  Certain taxable
income should be pro-rated based on your period of residency.  Fox example, if you owned a stock for the entire year and received a dividend of $1,000, but
moved to Philadelphia on July 1, 2018, only $500 of the dividend would be taxable.  If this was your only taxable dividend, you would enter $500 on Line 1 of
the tax return.
If income was realized on a specific date, your residency on that date will determine its taxability.  In the above example, if you had a short-term capital gain
(held six months or less) that was realized on June 1, 2018, none of that gain is taxable since you were not a Philadelphia resident on that date.  For further
information, contact the Technical Staff at   revenuetaxadvisors@phila.gov.
Filing status - A husband and wife may file a combined return.  However, losses from one spouse cannot be offset against gains from the other spouse.
   
Social Security Numbers - This return contains provisions for Social Security numbers.  If these spaces are blank, complete them.  Disclosure of Social
Security numbers is required pursuant to the provisions of Title 19 of the Philadelphia Code and regulations promulgated thereto.  Social Security numbers
are used to identify taxpayers and to ensure compliance of all City tax laws.  Social Security numbers are treated as confidential, except in the course of
Department of Revenue official business.
Change Form - If the preprinted information listed on the return is incorrect, use a Change Form to make the necessary corrections.  Find a Change Form at
www.phila.gov/tax-change.  For example, if your spouse is deceased but the preprinted information pertains to your spouse, use a Change Form to
indicate your name and Social Security number.
When to file - This return is due on or before April 15, 2019.    Failure to file and pay by this date will result in the imposition of interest and penalty.
Where to file - Sign the return and mail to:  Philadelphia Department of Revenue, P.O. Box 389, Philadelphia, PA   19105-0389.
Internet Filing - To file this return online, go to  ework.phila.gov/revenue.   After submitting the return you must print the resulting confirmation page
for your records.
Payment of tax - If the tax due on Line 14 of the School Income Tax return is $1 or more, make a check payable to "City of Philadelphia".  Do not remit tax
due if less than $1.  Internet filers can pay the tax due via debit card, credit card or e-check.  A user fee is added of 2.45% when paying by credit card  and
$5.95 when paying by debit card. Paying by E-Check is   FREE.
To pay in person, come to the Municipal Services Building, Concourse Level, 1401 John F. Kennedy Boulevard.  Non-cash payments may also be made at
7522 Castor Avenue and at 2761 North 22nd Street (Hope Plaza).
ACH Debits and Credits are accepted for payment of tax.  For more information or to enroll in this program go to   www.phila.gov/tax-change.  Contact the
Electronic Government Unit at 215-686-6582, 6579 or 6628 or e-mail to   egovservices@phila.gov.

Returned Checks. If your check is returned unpaid for insufficient or uncollected funds, (1) you authorize The City of Philadelphia or its agent to make a
one-time electronic funds transfer from your account to collect a fee of $20; and (2) The City of Philadelphia or its agent may re-present your check
electronically to your depository institution for payment.
Termination of School Income Tax filing responsibility - If you no longer have income subject to School Income Tax, use a Change Form to indicate the
termination of School Income Tax filing responsibility.  If the School Income Tax filing responsibility terminated prior to 2018, mail a Change Form indicating
the date of termination but   do not complete and mail the 2018 School Income Tax return.  Find a Change Form at   www.phila.gov/tax-change.
Contact information:  Send e-mail to   revenue@phila.gov or call   215-686-6600.  Additional returns and the Change Form can be downloaded from
www.phila.gov/revenue in the "Tax Forms & Instructions" section and require Adobe Acrobat Reader.

                                                          Interest, Penalties and Costs

   Effective January 1, 2014 - All taxes (except Real Estate) bear simple interest.  The annual rate shall be the
   Federal Short-Term Rate effective January 1 of such calendar year (26 § USCA 6621 et. seq.) plus five (5)
   percentage points.

   Penalty will be at the rate of 1¼% of the unpaid tax for each month or fraction thereof.

   For current interest rates, see the Department of Revenue's website at   www.phila.gov/revenue.

                                                                                                                               2018 SIT Inst.  9-19-2018
                                                                   Page 1

- 61 -

INSTRUCTIONS FOR PREPARING THE SCHOOL INCOME TAX RETURN
Read these instructions carefully to determine if you have income subject to the tax. Income from Federal
Schedule "C" business income and W-2 income should not be reported on the School Income Tax return.

Beginning with tax year 2016, proceeds from the Pennsylvania Lottery are now taxable.
Any net losses on Lines 1 through 8 of the return should be entered as "0". Losses may not be used to offset other types of income.
Print your numbers legibly and boldly within the spaces provided to ensure efficient and accurate processing of your return. Photocopies of
this return are not acceptable.
Line 1. All dividends are taxable unless they are a return of capital on a life insurance policy, from common stock of a National Bank, or from United
States government obligations. All other dividends are taxable regardless of the source. You cannot reduce this income by reinvested dividends.
Line 2. Interest income on the Federal or State tax return may be included. Examples of taxable interest include, but are not limited to: interest income
from securities, mortgages, private loans, insurance policies, bank notes, repurchase agreements, Fannie and Ginnie Mae obligations, and other sources.
The following are examples of non-taxable interest income:
A. Direct obligations of the Federal Government
B. Bonds or debt obligations of Pennsylvania or its political subdivisions
C. Interest on savings, checking, escrow and money market savings accounts that are deposited in:
1. Private Banks 4. Credit Unions
2. Building and Loan Associations 5. Savings Banks
3. Savings and Loan Associations 6. Bank and Trust Company or Trust Companies
Line 3. The distribution of income from a "Subchapter S" Corporation. For more information see Worksheet "S" on www.phila.gov/revenue.
Line 4. The pro rata share of any limited partnership income not otherwise subject to Philadelphia Net Profits Tax is taxable. If this is a net loss, enter
"0".
Line 5. Income from estates and trusts is taxable only if it is received by or credited to the beneficiary and is the type of income that would normally be
subject to this tax. For example, if the income from a trust consists of interest and dividends, the amount taxable would be determined as in
Lines 1 and 2 above.
Line 6. Net gains and losses are taxable from the sale of tangible and intangible personal property and real property held for six months or less. Note:
This holding period differs from the 12 months or less period used by the Federal Government to identify short term capital gains. If this is a net
gain, enter the gain on Line 6. If this is a net loss, enter "0".
Line 7. Net rental income received from the ownership of real or personal property is taxable unless the income is subject to Philadelphia Business
Income & Receipts and/or Net Profits taxes. If this is a net loss, enter "0". For School Income Tax purposes, report the net rental activity from a property
which meets all of the following three criteria:
1. It is the principal residence of the owner;
2. It is totally residential;
3. It consists of 3 rental units or less.
If the activity does not meet these criteria, you must file Business Income & Receipts and/or Net Profits taxes.

Owners of properties with 4 or more rental units must file the Business Income & Receipts and/or Net Profits tax returns. Rental units do not
include the unit occupied by the owner. (See BIRT Regulations Section 101 D. 8.).
Line 8. Report the following income: 1) royalty or copyright, 2) an award of punitive damages, 3) the monetary value of any prize or award, 4)
income from any annuity under a policy of insurance unless payable from a contract of employment as a part of retirement or pension plan, and
5) net proceeds from gambling (including Pennsylvania Lottery Cash Prizes). If this is a net loss, enter "0".
Line 9. Add Lines 1 through 8.
Line 10. You may include all reasonable expenses directly incurred in the production of taxable income if they were paid solely for the
production of that income. Examples of allowable expenses are: 1) safe deposit box rentals, 2) margin account interest, and 3) any fee paid in
2018 for the preparation of the School Income Tax return.
Line 11. Subtract Line 10 from Line 9.
Line 12. Gross Tax Due. Multiply Line 11 by .038809%.
Line 13. Enter here any credits from prior years and/or tax previously paid.
Line 14. TAX DUE. If Line 12 is greater than Line 13, enter the tax due on Line 14 and in the "Tax Due" box of the payment coupon.
Line 15A. If Line 13 is greater than Line 12, enter the amount of tax overpaid to be REFUNDED.

Line 15B. If Line 13 is greater than Line 12, enter the amount of tax overpaid to be APPLIED to the 2019 School Income Tax.
For more on filing the School Income Tax Return go to bit.ly/sitvideo.

2018 SIT Inst. 9-19-2018
Page 2

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                                                 CITY OF PHILADELPHIA DEPARTMENT OF REVENUE 

                                                              CHANGE FORM 
                         USE TO UPDATE ACCOUNT INFORMATION OR TO CANCEL A TAX LIABILITY 
 
                                                       MAIL THE COMPLETED CHANGE FORM TO: 
                 CITY OF PHILADELPHIA, DEPARTMENT OF REVENUE, P.O. BOX 1410, PHILADELPHIA, PA, 19105-1410 
                                                              OR FAX TO: 215-686-6635 
 
                        PHONE:  215-686-6600            E-MAIL:    revenue@phila.gov            INTERNET:        www.phila.gov/revenue 
 
  Businesses complete Sections 1                and 2to add a tax, request payment coupons or to close a business account.               For a change 
  of entity you must cancel your account and apply for a new Tax Account Number and Commercial Activity License. Contact 
  the department to obtain an application or to register on-line visit our web site. For property subject to Use and Occupancy 
  Tax complete           Section 3.     Individuals complete  Section 4 for School Income Tax or            Section 5       for Employee Earnings Tax. 
  Section 6 must be completed for all requests including the signature of the preparer of this form. 
 
 Section 1 - Business Tax Registration Information. 
  Currently Registered Business Name and Address                                        Corrected Business Name and Address 
                                                                                                                                  
         City Account Number             Employer Identification Number                  City Account Number          Employer Identification Number 
                                                                                                                 
                                                -                                                                            -              
                                                                                   
                                Social Security Number                                                      Social Security Number 
                                                                                   
                                -        -                                                                       -           -        
                                                                                   
                         Spouse's Social Security Number                                                Spouse's Social Security  Number 
                                                                                   
                                -        -                                                                       -           -        
 
 Section 2 - Add a tax, request payment                                                                                                        
 coupons or to cancel an account.                        If your business has closed, enter the last day of business:             -      -  
                                                                                                                                               
                                                                               To add a new tax type, enter the start date:       -      -        
  If your business never 
  materialized, check here:                                                                                                                    
                                                   ADD        CANCEL    COUPONS                                              ADD   CANCEL      COUPONS 
                                                                                       
         AMUSEMENT TAX                                                                      PARKING TAX 
   BUSINESS INCOME & RECEIPTS TAX                                                           USE & OCCUPANCY TAX 
   HOTEL TAX                                                                                VALET PARKING TAX 
   NET PROFITS TAX                                                                          VEHICLE RENTAL TAX 
   OUTDOOR ADVERTISING TAX                                                                  WAGE TAX 
                                                                                                        
 Section 3 - For property subject to Use and Occupancy Tax.                                             
  Property Address                                                                                      Business U&O Tax Account Number 
                                                                                                                                  - 
 
                                                                                                                Property Account Number 
                                                                                                                             
                                                                                                                 Cancellation Date 
 
  Use and Occupancy Tax Mailing Address (If different from Property Address)       
                                                                                                                 -           -        
 
                                                                                                                 Date of Purchase 
 
                                                                                                                 -           -        
 
  Check Reason for Cancellation:                                                       
                          Sold                    Residential                               Name of New Property Owner 
                          Vacant                  Other (Explain in Section 6) 
                                                                                                                                  83-E669 Rev. 10-22-2012

- 63 -

 Section 4                                         SCHOOL INCOME TAX 
   If the preprinted information listed on your tax return is incorrect, use this form to make the necessary corrections.  For example, if your spouse 
   is deceased and you filed jointly with your spouse, use the Change Form to indicate your name and Social Security number. 
 
  Currently Registered Taxpayer Name and Address      Corrected Taxpayer Name and Address                   
                                                                                                            
                   Social Security Number                                        Corrected Social Security Number 
                                                    
                          -    -                                                          -        -        
                                                     
               Spouse's Social Security Number                                  Corrected Spouse's Social Security           Number 
                                                     
                          -    -                                                          -        -        
 
                                                                                                           Cancellation Date 
   Reason          Moved out of Philadelphia          Spouse Filing Separately 
   for                                                                                                -                       -        
  Cancellation     Deceased.  Enter date of death     No taxable Income 
                                                                                                                               
 Section 5                                         EMPLOYEE EARNINGS TAX 
 
  Currently Registered Taxpayer Name and Address      Corrected Taxpayer Name and Address                   
                                                                                                            
                   Social Security Number                                        Corrected Social Security Number 
                                                    
                          -    -                                                          -        -        
 
                                                                                                   Cancellation               Date 
   Reason          Moved out of Philadelphia       Employer now withholding tax 
           for                                                                                     -        -        
   Cancellation    Deceased                        No longer employed 
                                                                                                                              
 Section 6                              State the reason for submitting this change form: 
 
                              Contact information must be completed for all change requests. 
 
               Form Completed By (print name):                                            Date 
 
               Signature:                                                                 Telephone # 
 
               E-mail Address                                                             Fax #

- 64 -

          Scan Line Check Digit Calculation Method and Example 
 
 The coupon has a check digit (position 68) for the entire scanline.  The check digit has to be calculated 
 for the remaining scanline of length 67. 
 
 1.  Each digit of the 67 digits is multiplied by the following weights, which are assigned to the digits of the 
 field from left to right: 2,1,2,1,2,1 etc. 
 
 2.  Subtract the sum of the digits from the next highest number equally divisible by 10. The remainder is 
 the check digit. 
 
 Example: 
 
 All Fields: 33301040898000000004562062000000000000000000000001498000000000000007 
 
 Multiplier: 212121212121212121212121212121212121212121212121212121212121212121 
 
 Result: 
 63602080(16)9(16)0000000049(10)640(12)200000000000000000000000189(16)00000000000000 
 
 Sum of Digits = 93 
 
 93 mod 10 = 3 (93 divided by 10 = 9, remainder 3) 
 
 10 – 3 = 7 (Scanline in position 68)

PDF file checksum: 881843072

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