W 2-R Annual Reconciliation of
               PO Box 25113                           Earned Income Tax Withheld From Wages                                                       *W2R*
               Lehigh Valley, PA 18002-5113           As reported on Employer’s Quarterly Return (Form E-1);
                                                      with income tax withheld as shown on                                                        W 2R
                                                                           Withholding Statements (W-2)

                                                                                                      Year:  
                                                                                                      D ue by
                                                                                                      Last Day of February
                                                                                                           Filed Online
                                                                                                           *see instructions   W2

                                                                                               Please complete information requested and remit to:
                                                                                               HAB - EMP REC
                                                                                               PO Box 25113
                                                                                               Lehigh Valley, PA 18002-5113
                                                      Y ou are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and
                                                      c ollection of local taxes by calling Berkheimer at 610-599-3182.  Or, you can visit our website at www.hab-inc.com. 
                                                      B erkheimer is not the appointed tax hearing officer for your taxing district and will not accept any petitions for appeal.
Please see reverse for instructions                   P etitions for appeal must be filed with the appropriate appeals board for your County. Berkheimer can provide you with the
                                                      p roper procedures and forms necessary to file an appeal with the appeals board for your Tax Collection District.
Employer Name 

A d d r e s s  

City                                                                                                       State     Zip

Municipal Location of Business

PSD Number                  Employer Acct No.         Federal ID No.                                             TCD Filed With

1.  Total number of withholding statements (W-2s) accompanying this report 
2.  Total income tax withheld from all wages during the year as shown on (W-2s)                                  (A)     $
                                                                                                                               ,                  .
                                                                                EARNED INCOME TAX                              Tax Paid
                                                                                Quarter ended March 31 ....................$
                                                                                                                               ,                  .
                                                                                Quarter ended June 30 ...................... $
                                                                                                                               ,                  .
                                                                                Quarter ended September 30 ............ $
                                                                                                                               ,                  .
                                                                                Quarter ended December 31 ..............$
                                                                                                                               ,                  .

3.  Total quarterly income tax from wages during the year as reported on Quarterly E-1 Reports                   (B)     $
                                                                                                                               ,                  .
               WEB

                                                                                                      TOTAL AMOUNT OF
                                                                                                      ENCLOSED CHECK           ,                  .
4.  Any difference between A and B must be explained in attached statement.  Where A and B do not agree, please remit or request refund.
     I DECLARE UNDER PENALITES PROVIDED BY THE LAW THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST
     OF MY KNOWLEDGE IS A TRUE, CORRECT AND COMPLETE RETURN.

     Signature_______________________________________________ Phone___________________________   Date_______________
     There will be a $29.00 fee for returned payments.
     There will be an additional fee assessed if no payment is enclosed for tax due at time of filing.

              INSTRUCTIONS FOR FORM W-2R

1. Include municipal location of business in PA, assigned account number and Federal ID number.  Include employer’s full name
  and address.

2.If no balance is due, the W2 Reconciliation can be filed online on or before the last day of February following the close of the
  c alendar year at:  www.berk-e.com, or return the reconciliation form.  If a balance is due, online filing is still available, but payment
  must be submitted to the address below, along with this completed form with the “Filed Online” box checked.  This form must be
  accompanied by CITY INCOME TAX copy or facsimile of the Form W-2 if a file has not been submitted electronically for each
  employee from whom income tax has been withheld during said year.  

3. The total of all income tax withheld as reflected on W-2s should be entered on line 2.  Total Earned Income Tax as reported on
  a quarterly basis should be entered on line 3.

4.Payment is due, if applicable, when filing the reconciliation. Complete the reverse side of this form and mail to the address
  below.  Include the employee name, SSN, address, municipality and amount being paid with the reconciliation.

5.If an employer’s total payroll consists of a number of separate units or establishments, the Form W-2 should be assembled
  accordingly and a separate reconciliation Form W-2 should be submitted.

              Remit to:
              HAB - EMP REC
              PO Box 25113
              Lehigh Valley, PA 18002-5113