EIT
                                                      W2-R Annual Reconciliation of Earned Income Tax Withheld From Wages
                                                                As reported on Employer’s Quarterly Return (Form E-1); with income tax withheld as shown 
            PO Box 25113                                                                            on Withholding Statements (W-2)                                                          *W2R*
            Lehigh Valley, PA 18002-5113                                         PAGE             OF
                                                                                                                                                                                             W2R

                                                                                                                                                      Please see reverse for instructions.
                                                                                                                                                                                             Scan for FAQs 
                                                                                                                                                                                             or to file online

                                                                                                                                                      W2

                                                                                                                                                      Year:  
                                                                                                                                                      Due by Last Day of February
                                                                                                                                                               Filed Online (see instructions)
Employer Name                                                                    WEB

Address 

City                                                                                                                                     State              Zip

Municipal Location of Business

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

EMAIL: Your email on file appears above.  If email is incorrect or blank, please provide below.

Phone Number: Your phone number on file appears above.  If phone is incorrect or blank, please provide below.  By providing your number, you agree to allow us to contact you regarding your account by phone.

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)      $
                                                                                                                                                                              ,                      .

                                                                                 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 PENALTIES 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.

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.  
 
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. 

                 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 
    calendar 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