Employer Annual Reconciliation of Quarterly Returns
2009 FOR CALENDAR YEAR 2009
BELLWOOD-ANTIS SCHOOL DISTRICT AND MUNICIPALITY
THIS RETURN MUST BE FILED BY FEBRUARY 1, 2010
1. Total income tax withheld on wages 2. Total income tax withheld on wages during the tax year.
during the tax year as shown by copies
of employee’s statements for income Quarter ending:
tax withheld on wages (Forms W-2) $_______________________________________ (A) March 31
(Please forward W-2 forms in alphabetical order.) September 30
NOTE: Any discrepancy between the amounts shown on Lines (A) and (B)
must be fully explained in an attached statement.
COMMENTS: (For Office Use Only) l.The original of this reconciliation form must be filed at the same
time as your withholding tax return (Employers Quarterly Earned
Income Tax Return), Form WR- 1, for the fourth quarter of the tax
year (unless you ceased having employees before December 31,
of the tax year in which case it must be filed within 30 days after
the last payment of wages). This form must be accompanied by a
Form W-2 for each employee from whom tax has been withheld
during the year. You must send this form and the Forms W-2 in
time to reach the Bellwood -Antis School District Tax Office, Martin
Street, Bellwood, PA 16617, not later than January 31, of the tax year.
2. You should send with these forms an adding machine tape or
some other type of list showing how you obtained the total of tax
withheld as shown on all Forms W-2. This total will be entered on
line (A) on the face of this form and should be in agreement with
the amount shown on line (B). Any discrepancy between the two
amounts must be fully explained on an attached statement.
PREPARER SIGNATURE DATE PHONE NUMBER
BELLWOOD-ANTIS SCHOOL DISTRICT TAX OFFICE
300 MARTIN STREET
BELLWOOD, PA 16617