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PAGE OF
EMPLOYER QUARTERLY RETURN
PO Box 25132 Local Earned Income Tax Withholding
Lehigh Valley, PA 18002-5132
DCEDE11
You are entitled to receive a written explanation of your rights with regard to the audit,
appeal, enforcement, refund and collection of local taxes by calling Berkheimer at
610-599-3182. Or, you can visit our website at www.hab-inc.com.
Mailing Address: Berkheimer is not the appointed tax hearing officer for your taxing district and will not
accept any petitions for appeal. Petitions for appeal must be filed with the appropriate
appeals board for your County. Berkheimer can provide you with the proper procedures
and forms necessary to file an appeal with the appeals board for your Tax Collection
District.

Location of Business dced-e1-web 011216

Year / Quarter

Account #

Municipal Taxing Authority (City, Borough, or Township) in Which Facility or Business is Located(Attach listing of multiple locations within PA if applicable)

County Business Phone Number (if above is incorrect) Business Fax Number

Employer PSD Code Federal EIN or Social Security # Account Number Year Quarter

M M D D Y Y Y Y
1. Total Earned Income Tax withheld........................... 8. Date period ended (MM/DD/YYYY)............
2. Credit or adjustment ()...............attach explanation ,
. 9. Total pages of this Return ...........................
3. Total of Earned Income Tax due ,
(line 1 minus line2)........... . 10. Total number of employees listed ...................
4. Total payments made this quarter, If there has been a change of ownership or other transfer of business during the
(Schedule B).............................. . quarter, attach explanation and give name of present owner and date the change
5. Adjusted total of Earned Income Tax due , took place.
(line 3 minus line 4)......... .
6. Interest(0.246% per month (or a fraction of) if paid , Change No Change
after the due date x line 5)...................................... .
,
. Do you expect to pay taxable wages next quarter?
, Yes No
7.Balance due with Return(add lines 5 and 6).................
,
Under penalties of perjury, I (we) declare that I (we) have examined this information,. including all accompanying schedules and statements and to the best of my (our) belief, they
are true, correct and complete
Primary Contact Individual (First Name, Last Name)

Title

Primary Contact Phone NumberPrimary Contact Email Address

Signature of Primary Contact Individual Date (MM/DD/YYYY)

(11) Employee’s(12) Employee’s Name/Address(13) Gross Compensation(14) Amount of EIT(15) Resident
Check if making any corrections to Employee’s
Social Security NumberName/Address, SSN or Resident PSDPaid This QuarterWithheld This QuarterPSD Code

, . , .

, . , .
(16) First Page Total .........................................................
Make Checks payable to: HAB-EIT , , . , .
There will be a $29.00 fee for returned payments. Total Amount Enclosed.....$
There will be an additional fee assessed if no payment is enclosed for tax due at time of filing. , , .

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                                                                                                                      PAGE        OF
EMPLOYER QUARTERLY RETURN for Local Earned Income Tax Withholding

Employer Business Location:
                                                                                                                      DCEDE12

Mailing Address:

                                                                                                                                    dced-e12-web    040912
 
                                                                                Year / Quarter

                                                                                Account #

(11) EMPLOYEE'S        (12) EMPLOYEE'S NAME/ADDRESS                  (13) GROSS COMPENSATION    (14) AMOUNT OF EIT    (15) RESIDENT
SOCIAL SECURITY NUMBER Check if making any corrections to EMPLOYEE’S          PAID THIS QUARTER WITHHELD THIS QUARTER PSD CODE
                           Name/Address, SSN or Resident PSD

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(16 THIS PAGE TOTAL ................................................
                                                                    ,         , .               , .
                                                                    2016.01.12

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                                                                                                           DCED-E1-BaCK117  011817
WHo muSt FIlE:                           InStruCtIonS
If  you      have             employed   one                                      or    more           individuals, other than  domestic servants, for a salary, wage, commission, 
or  other             compensation,      you                                         must      file      a return for the first quarter in which you   are required to withhold the 
Earned Income tax from earnings, and each quarter thereafter.  
If you have no employees for a tax period, a return must be filed indicating "no employees" for that quarter. all pennsylvania
based  employers  are  required  to  withhold  the  tax  based  on  the  higher  rate  of  either  the  employee’s  resident  tax  rate  or
employer’s non-resident tax rate.
QuartErly rEturnS anD DuE DatES:  a return must be filed for each quarter of the calendar year on the dates listed below
unless the date falls on a Saturday or Sunday then the due date becomes the next business day.
1st quarter: January, February, march ..................................april 30Due on or Before   
2nd quarter: april, may, June ................................................Due on or Before July 31
3rd quarter: July, august, September ...................................Due on or Before       october 31
4th quarter: october, november, December .........................JanuaryDue on or31Before
NOTE: Delinquent fee may be assessed for failure to file a required Employer Quarterly Earned Income Tax return.
WHErE to FIlE:
to file your Employer Quarterly return electronically, visit our website at www.berk-e.com.        
If you choose not to use an online filing option, you can mail your return and payment to the address noted at the bottom of this form.

                                         EmployEr QuartErly rEturn
ItEm 1:total Earned Income tax withheld from all employees' wages during the quarter.
ItEm 2:Credit or adjustment (attach explanation). line is for the correction of tax withheld for the preceding quarter(s) of the
    same  calendar  year.      Explanation  should  include  details  showing  year/quarter,  social  security  number  (s)  and  the
    revised amount for each individual. 
ItEm 3:total of Earned Income tax Due (line 1 minus line 2)
ItEm 4:total payments made this quarter. 
ItEm 5:adjusted total of EIt Due (line 3 minus line 4).
ItEm 6:Interest must be calculated at the rate indicated, per month (or days) after due date. multiply rate by line 5.
ItEm 7:Balance due with return (add lines 5 and 6).
ItEm 8 tHru 12:these items are self-explanatory. note: Item 12 must be employee’s street address. po Boxes are not
                    acceptable addresses for filing purposes
ItEm 13:Gross Compensation paid this Quarter - list Gross Wages paid to each employee this quarter.
    With the passage of pennsylvania act 48 of 1994, it is no longer possible for us to remit to the City of philadelphia any
    monies which you have collected for employees.  If you need to set up an account with the City of philadelphia you
    may call them at 215-686-6600.
ItEm 14:amount  of  tax  Withheld  this  Quarter-  list  amount  of  Earned  Income  tax  Withheld  by  you  for  each  employee 
    this quarter.  Enter “0” if no tax withheld this quarter for employee listed. 

ItEm 15:pSD Code - please list for each employee the 6 digit pSD Code of the CIty, BorouGH, or toWnSHIp in which the
    employee resides so the Earned Income tax administrator may distribute the tax to the proper taxing jurisdiction.

ItEm 16:Include total taxable Gross Wages and Earned Income tax Withheld.

                                         ADDITIONAL FILING INSTRUCTIONS
the Employer Quarterly return has been prepared by the Earned Income tax office to the Department of Community and Economic Development (DCED).
When the front of this form has employees listed in sections 11-15 it is based on the list of employees submitted by the employer. In order to assure proper credit to
your account, employers are required to perform the following:
    §  CHECK tHE BoX to the left of each employee if any changes or additions are made to that line.  address changes submitted
       must be actual street address of the employee.  po Boxes are not acceptable addresses for filing purposes.
    §  Draw  a  line  through  the  name  of  any  employee  who  has  terminated  employment  for  any  reason  prior  to  the  end  of 
       the preceding quarter.
    §  Write a "0" in column fourteen (14) for any employee who has had a leave of absence and received no taxable 
       earnings during the quarter.
    §  Indicate any change or correction in employee's name, address, social security number, or resident taxing 
       jurisdiction (pSD).  add if not shown.
    §  add the name, address, social security number and correct taxing jurisdiction of any new employee.

                                     rEmIt to:
                                        BErKHEImEr taX InnoVatIonS
                                        po BoX 25132
                                        lEHIGH VallEy, pa 18002-5132
                                                                                                                      2017.02.09

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