R ETURN THIS ENTIRE SHEET WITH YOUR PAYMENT
                                                                                B USINESS PRIVILEGE AND/OR MERCANTILE TAX RETURN
                                                                                Re:                                        Tax Year:
                            PO BOX 21810   LEHIGH VALLEY, PA 18002-1810
                            (610) 599-3140
                            Office Hours:  Monday thru Friday 9:00 am to 4:00 pm

                                                                                District:

                                                                                Account Number:
                            Name:

                            Address:                                                                                                                        *STD*
                            City,
                            State,
                            Zip                                                                                  D O NOT WRITE IN BOX

                                                   POSTMARK DATE OF POST OFFICE ACCEPTED  — NO EXTENSIONSWEB
                                          Failure to receive a tax return does not entitle owner to disregard the penalty or interest on taxes owed.
SECTION A: COMPUTATION OF GROSS VOLUME OF BUSINESS ON REVERSE SIDE                                                 TAX DUE ON OR BEFORE  
SECTION B: FINAL TAX - BUSINESS PRIVILEGE AND/OR MERCANTILE TAX RETURN
NATURE OF GROSS VOLUME OF BUSINESS                            E XEMPTIONS & EXCLUSIONS   TAXABLE VOLUME          TAX RATE                           AMOUNT OF TAX DUE
                            B USINESS ROUND TO NEAREST DOLLAR ROUND TO NEAREST DOLLAR    ROUND TO NEAREST DOLLAR                                    ROUND TO NEAREST DOLLAR

1. Service                            ,            ,           ,       ,                         ,        ,      x                                  ,   ,
2. Rentals                            ,            ,           ,       ,                         ,        ,      x                                  ,   ,
3 . Retail                            ,            ,           ,       ,                         ,        ,      x                                  ,   ,
4. Wholesale                          ,            ,           ,       ,                         ,        ,      x                                  ,   ,
5.  TOTAL TAX DUE (Add lines 1, 2, 3, & 4)                                                                                                          ,   ,
6.  Less last year’s credit and/or estimated payment (excluding penalty & interest)                                                                 ,   ,
7.  SUBTOTAL (Line 5 minus Line 6)                                                                                                                  ,   ,
8.  Add interest of                                                                      (after due date)                                           ,   ,
9.  Add penalty of                                                                       (after due date)                                           ,   ,
10. TOTAL SECTION B (Add Lines 7, 8, & 9)                                                                                                           ,   ,
SECTION C: ESTIMATED TAX - BUSINESS PRIVILEGE AND/OR MERCANTILE TAX RETURN
NATURE OF GROSS VOLUME OF BUSINESS                            E XEMPTIONS & EXCLUSIONS   TAXABLE VOLUME                                             AMOUNT OF TAX DUE
                            BUSINESS  ROUND TO NEAREST DOLLAR ROUND TO NEAREST DOLLAR    ROUND TO NEAREST DOLLAR TAX RATE                           ROUND TO NEAREST DOLLAR

11. Service                           ,            ,           ,       ,                         ,        ,      x                                  ,   ,
12. Rentals                           ,            ,           ,       ,                         ,        ,      x                                  ,   ,
13. Retail                            ,            ,           ,       ,                         ,        ,      x                                  ,   ,
14. Wholesale                         ,            ,           ,       ,                         ,        ,      x                                  ,   ,
15.  TOTAL ESTIMATED TAX DUE (Add Lines 11, 12, 13, & 14)                                                                                           ,   ,
16.  Add interest of                                                                     (after due date)                                           ,   ,
17.  Add penalty of                                                                      (after due date)                                           ,   ,
18. TOTAL SECTION C (Add Lines 15, 16 & 17)                                                                                                         ,   ,
19. TOTAL AMOUNT DUE (Add Lines 10 & 18)                                        PAYMENT DUE BY                                                      ,   ,
                            E.I.N. # _____________________                               Please check one:       Refund Due
                            BUSINESS TELEPHONE ____________________________                                      No Payment Due
                            DATE OPERATION BEGAN IN DISTRICT _______________             *STD*                   Payment Included

                                                                                DO NOT TEAR APART
                                                                                                            NO CASH PAYMENTS WILL BE ACCEPTED.
                                                                                                            Your cancelled check is your receipt of payment.
BUSINESS PRIVILEGE AND/OR MERCANTILE TAX RETURN                                                             There will be a $29 fee for returned checks.
Make any corrections to Business Name & Address and check here.
                                                                                                 Tax Year:
Business Name:
                                                                                                 Re:

                                                                                                 District:

                                                                                                 Account Number:
Make check payable to and remit to:
                                      HAB-BPT
                                      PO BOX 21810                                               Amount of Payment: $ _____________________
              470                     LEHIGH VALLEY, PA   18002-1810
              e  
                                                                                                            DO NOT WRITE BELOW THIS LINE
              m rr-ecewb 022

                            *STD*