Or, you can fill in and print the forms below. (Please note that any information that you type into this form will NOT BE SAVED!)
Year:
Tax Office Use Only
Account Number:
Tax Received:
Employer Name:
Interest:
Address:
Penalty:
Total Paid:
City/State/Zip:
Check/M.O.:
Employee SS#
Employee Name
Employee Address
PSDI
Gross Wages
Tax Withheld
Total Paid:
Make Checks Payable to: Southwest Regional Tax Burea (S.W.R.T.B.)
Please include Account Number on check.
Under penalties of perjury, I declare that I examined this return including accompanying schedules and statements, and to the best of my knowledge and belief are true and correct.
Signiture:
Date:
EMPLOYER'S QUARTERLY WAGE TAX INSTRUCTIONS
Amending the Act of December 31, 1965 (PL. 1257, No. 511) Act 210
effective July 15, 1976, providing for the distribution of the Earned Income
Taxes collected for the political subdivisions. It will be necessary for each
employer to submit a listing by name, social security number, gross earnings
and tax withheld so that we may properly credit the political subdivision and
individuals account. It will be necessary for the employer to identify the
individuals political subdivision as the bureau will match the list submitted
by each employer against its master file to identify the proper political
subdivision. It will be necessary that all new employees file an IT-5 so that
a master record can be set up for the individual stating the political
subdivision and school district in which they reside.
On or before February 28, of the succeeding year, every employer shall
file with the officer:
An annual return showing the total amount of earned income paid, the
total amount of tax deducted and the total amount of tax paid to the
officer for the period beginning January 1, of the current year and
ending December 31, of the current year.
A return withholding statement for each employee employed during all
or any part of the period beginning January 1, of the current year and
ending December 31, of the current year, setting forth the employee's
name, address, social security number and the amount of earned income
paid to the employee during said period, the amount of tax deducted, the
political subdivisions imposing the tax on such employee and the amount
of tax paid to the officer. Every employer shall furnish two (2) copies
of the individual return to the employee for whom it is filed.
The earned income tax is based on gross earnings earned, paid,
or received during the tax year. Taxable income includes, but not limited to,
wages, salaries, bonuses, tips, commissions, fees and other earned income such
as vacation pay, separation payments and taxes assumed by the employer for the
employee.
Failure to receive a tax return does not excuse the employer/business
and/or its representatives from filing the return or paying the tax due.
Failure to file quarterly will result in a three percent (3%) interest
charge. After February 28th interest at 1/2 % per month or
fractional month will be charges from due date until the tax is paid.
Penalty at 1/2% per month or fractional month will be charged from the due
date until the tax is paid. Minimum charge is $1.00 per quarter.
Improperly executed or unsigned forms will be considered delinquent. Forms
must show the actual taxable income, the tax due, the total payment enclosed
and other requirements.
If filing by mail, please return the completed form and attach your check
or money order with your account number written on it. Include a
self-addressed stamped envelope if a receipt is desired.
If your payment is forwarded after the due date indicated on this form,
compute and include interest with your remittance. Otherwise, the tax
collector will invoice you the same plus additional costs.
For those employers that have computerized payrolls, the bureau will
accept a computerized listing with the required information, provided the
information is complete and legible to read. W-2's must be provided at the end
of the year.
Do not automatically deduct credit for a prior period on this form. You
must apply for a refund for any overpayments.
Include form IT-5 for each new employee for whom you will be withholding
local tax. This form indicates their name, address, social security number,
school district and municipality in which they reside. This information is
very important and must be done in order to properly process your quarterly
returns. IT-5 forms are sent upon request and available online.
Every employer who discontinues business prior to December 31, of the
current year, shall within thirty (30) days after the discontinuance of
business, file the returns and withholding statements herein above required
and pay the tax due.
Failure, refusal or neglect to make a return required, or to pay the tax
imposed shall render the person(s) liable to a fine of $500.00 plus costs
and/or thirty (30) days in jail. (P.L. 1257, No. 511)