Form Birt-Ez - Business Income & Receipts Tax - 2016
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1
22016 BIRT-EZ
CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE
No
Staples
2016 BUSINESS INCOME & RECEIPTS TAX
2
4
1
1
6
For business conducted 100% in Philadelphia
DUE DATE: APRIL 18, 2017
City Account Number
Taxpayer Name and Address
EIN
SSN
Taxpayer E-mail Address
If this is a change of address, check this box:
If your business terminated in 2016, enter the termination date AND file a CHANGE FORM.
m m d d y y y y
YOU MUST COMPLETE WORKSHEET "S-EZ"
If this is an amended return place an "X" here:
COMPUTATION OF TAX DUE OR OVERPAYMENT
1. NET INCOME PORTION OF TAX (from Page 2, Line 6).
.00
If there is no tax due, enter "0"............................................................................................
1.
2. GROSS RECEIPTS PORTION OF TAX (from Page 2, Line 11).
.00
2.
If there is no tax due, enter "0"............................................................................................
.00
3. Tax Due for the 2016 Business Income & Receipts Tax (Line 1 plus Line 2).......................
3.
.00
4.
4. MANDATORY 2017 BIRT Estimated Payment (See Instructions)...................................
.00
5. Total Due by 4/18/2017 (Line 3 plus Line 4).......................................................................
5.
ESTIMATED PAYMENTS AND OTHER CREDITS
6a. Include any estimated and/or extension payments of 2016 BIRT previously made,
.00
and any credit from overpayment of the 2015 BIRT and/or 2016 NPT return..................
6a.
.00
6b. Credit from Special Credit Schedule (SC). (Cannot exceed amount on Line 3)...................
6b.
.00
6c. Total payments and credits. (Line 6a plus Line 6b)..............................................................
6c.
7. Net Tax Due (Line 5 less Line 6c).
.00
7.
If Line 6c is greater than Line 5, enter "0".............................................................................
8. Interest and Penalty
.00
8.
Refer to web site for current percentage...................................................................... ........
9. TOTAL DUE including Interest and Penalty (Line 7 plus Line 8).
.00
9.
Use payment coupon. Make check payable to: "City of Philadelphia".........................
OVERPAYMENT OPTIONS If Line 6C is greater than Line 5, enter the amount to be:
.00
10a.
10a. Refunded. Do not file a separate Refund Petition...........................................................
.00
10b. Applied to the 2016 Net Profits Tax Return..........................................................................
10b.
.00
10c. Applied to the 2017 Business Income & Receipts Tax.........................................................
10c.
Under penalties of perjury, as set forth in 18 PA C.S. §§ 4902-4903 as amended, I swear that I have reviewed this return
and accompanying statements and schedules, and to the best of my knowledge and belief, they are true and complete.
Taxpayer Signature________________________________________ Date_______________________Phone #_________________________
Preparer Signature_________________________________________ Date_______________________Phone #_________________________
BIR-EZ 1 Rev. 7-27-2016
Page 1
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