Form Birt-Ez - Business Income & Receipts Tax - 2012
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2012 BIRT-EZ
CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE
2012 BUSINESS INCOME & RECEIPTS TAX
0
1
1
2
For business conducted 100% in Philadelphia
DUE DATE: APRIL 15, 2013
City Account Number
Taxpayer Name and Address
Federal Identification Number
Social Security Number
If this is an amended return place an "X" here:
YOU MUST USE THE CHANGE FORM TO REPORT A CHANGE OF ADDRESS!
If your business terminated in 2012, enter the termination date AND file a CHANGE FORM.
mm-dd-yyyy
DO NOT ENTER AN AMOUNT ON LINE 4.
COMPUTATION OF TAX DUE OR OVERPAYMENT
1. NET INCOME PORTION OF TAX (from Page 2, Line 5).
.00
If there is no tax due, enter "0"............................................................................................
1.
2. GROSS RECEIPTS PORTION OF TAX (from Page 2, Line 8).
.00
If there is no tax due, enter "0"............................................................................................
2.
.00
3. Tax Due for the 2012 Business Income & Receipts Tax (Line 1 plus Line 2).......................
3.
.00
4. MANDATORY 2013 BIRT Estimated Payment (repeat Line 3).........................................
4.
.00
5.
5. Total Due by 4/15/2013 (Line 3 plus Line 4).......................................................................
ESTIMATED PAYMENTS AND OTHER CREDITS
.00
6a. Credit from overpayment of 2011 or 2012 Net Profits Tax....................................................
6a.
6b. Include any estimated and/or extension payments of 2012 BIRT previously made,
.00
and any credit from overpayment of the 2011 BIRT return..............................................
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.
Multiply Line 7 by the cumulative percentage from the chart on the Information Sheet ........
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, up to the tax due, to the 2012 Net Profits Tax Return.............................................
10b.
.00
10c. Applied to the 2013 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 #_________________________
0112 Web Rev. 11-20-2012
Page 1
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