Local Earned Income Tax Return Pa Eit 2015 Page 3
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1
2
3LOCAL EARNED INCOME TAX PAYMENT VOUCHER
TAX YEAR
EIT
BERKS E.I.T. BUREAU |
20
Form
Phone: (610) 372-8439 | Toll Free: (855) 372-8439 | Fax: (610) 372-1102
Office Use Only
TAXPAYER A
SPOUSE B
Social Security Number
Social Security Number
TAXPAYER A - LAST NAME, FIRST NAME, MIDDLE INITIAL
-
-
-
-
SPOUSE B - LAST NAME, FIRST NAME, MIDDLE INITIAL
19. TOTAL PAYMENT DUE
(From Line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
19
AMOUNT ENCLOSED
Make Checks payable to "Berks EIT Bureau"
0.00
CHECK HERE IF PAYING BY CREDIT CARD
Please write your social security number(s) on your check.
There will be a $20.00 fee for returned checks for insufficient funds.
CREDIT CARD PAYMENTS: Can be made through our website or by phone 1-800-272-9829. VISA, MasterCard,
American Express and Discover are accepted. All credit card payments are through a third party company, Official Payments
Corporation. It is a simple, safe, and convenient payment option. There is a fee charged by Official Payments Corporation for
utilizing this service. The Jurisdiction Code for Berks EIT Bureau is 4845. At several points in the transaction process, you will
be informed of the fee charged by Official Payments Corporation. If you have any questions about this method of payment,
please contact our office.
YOU ARE STILL REQUIRED TO FILE YOUR LOCAL TAX RETURN WITH APPROPRIATE SUPPORTING DOCUMENTATION.
Please check the payment by credit card box on the tax form.
Where to send your return:
Payment Returns
Refund/Credit Requested Returns:
No Payment/No Refund/NoCredit Due:
PAYMENT ENCLOSED
REFUND/CREDIT REQUESTED
NO PAYMENT/NO REFUND
BERKS EIT BUREAU
BERKS EIT BUREAU
BERKS EIT BUREAU
PO BOX 6365
PO BOX 6366
PO BOX 6367
WYOMISSING, PA 19610-365
WYOMISSING, PA 19610-
WYOMISSING, PA 19610-
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