Form DCEDE11REM "Employer Quarterly'(return Local'(earned Income Tax Withholding" - Pennsylvania

What Is Form DCEDE11REM?

This is a legal form that was released by the Berkheimer Tax Administrator - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 9, 2012;
  • The latest edition provided by the Berkheimer Tax Administrator;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCEDE11REM by clicking the link below or browse more documents and templates provided by the Berkheimer Tax Administrator.

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Download Form DCEDE11REM "Employer Quarterly'(return Local'(earned Income Tax Withholding" - Pennsylvania

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EMPLOYER QUARTERLY RETURN
PAGE 1 OF 1
Local Earned Income Tax Withholding
DCEDE11REM
PO Box 25132
Make any corrections to EMPLOYER'S NAME & ADDRESS and check here.
Lehigh Valley, PA 18002-5132
D EDE11REM
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
Name
District.
Location of Business
Address
Year / Quarter
Address
Account #
City
St
Zip Code
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...........................
9. Date period ended (MM/DD/YYYY)............
,
.
2. Credit or adjustment (attach explanation)...............
10.. Total pages of this Return ...........................
,
.
3. Total of Earned Income Tax due
11. Total number of employees listed ...................
(line 1 minus line2)...........
,
.
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).........
,
.
Change
No Change
6. Interest ( 0.246% per month (or a fraction of) if paid
after the due date x line 5)......................................
,
.
Do you expect to pay taxable wages next quarter?
7. Late Filing Fee.......................................................
Yes
No
8. Balance due with Return (add lines 5+6+7) .................
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 Number
Primary Contact Email Address
Signature of Primary Contact Individual
Date (MM/DD/YYYY)
(13) Employee’s Name/Address
(15) Amount of EIT
(12) Employee’s
(14) Gross Compensation
(16) Resident
Check if making any corrections to Employee’s
Social Security Number
Paid This Quarter
Withheld This Quarter
PSD Code
Name/Address, SSN or Resident PSD
,
.
,
.
.
,
,
.
,
.
,
.
,
.
,
.
,
,
.
,
.
(17) First Page Total .....................................................
Print
Make checks payable to: HAB-EIT
,
,
.
Total Amount Enclosed..... $
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.
EMPLOYER QUARTERLY RETURN
PAGE 1 OF 1
Local Earned Income Tax Withholding
DCEDE11REM
PO Box 25132
Make any corrections to EMPLOYER'S NAME & ADDRESS and check here.
Lehigh Valley, PA 18002-5132
D EDE11REM
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
Name
District.
Location of Business
Address
Year / Quarter
Address
Account #
City
St
Zip Code
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...........................
9. Date period ended (MM/DD/YYYY)............
,
.
2. Credit or adjustment (attach explanation)...............
10.. Total pages of this Return ...........................
,
.
3. Total of Earned Income Tax due
11. Total number of employees listed ...................
(line 1 minus line2)...........
,
.
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).........
,
.
Change
No Change
6. Interest ( 0.246% per month (or a fraction of) if paid
after the due date x line 5)......................................
,
.
Do you expect to pay taxable wages next quarter?
7. Late Filing Fee.......................................................
Yes
No
8. Balance due with Return (add lines 5+6+7) .................
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 Number
Primary Contact Email Address
Signature of Primary Contact Individual
Date (MM/DD/YYYY)
(13) Employee’s Name/Address
(15) Amount of EIT
(12) Employee’s
(14) Gross Compensation
(16) Resident
Check if making any corrections to Employee’s
Social Security Number
Paid This Quarter
Withheld This Quarter
PSD Code
Name/Address, SSN or Resident PSD
,
.
,
.
.
,
,
.
,
.
,
.
,
.
,
.
,
,
.
,
.
(17) First Page Total .....................................................
Print
Make checks payable to: HAB-EIT
,
,
.
Total Amount Enclosed..... $
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.
Print
PAGE
OF
EMPLOYER QUARTERLY RETURN for Local Earned Income Tax Withholding
Employer Business Location:
DCEDE12
Mailing Address:
Name
Address
Address
Year / Quarter
City
St
Zip Code
Account #
(12) EMPLOYEE'S NAME/ADDRESS
(14) AMOUNT OF EIT
(13) GROSS COMPENSATION
(15) RESIDENT
(11) EMPLOYEE'S
Check if making any corrections to EMPLOYEE’S
SOCIAL SECURITY NUMBER
PAID THIS QUARTER
PSD CODE
WITHHELD THIS QUARTER
Name/Address, SSN or Resident PSD
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Print
(16 THIS PAGE TOTAL ................................................
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