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Question	Answer
Form Name	Pa W3R
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	pa w3, pa w3r, pa return withheld, pa w3 quarterly form pdf

12

Form Preview Example

INSTRUCTIONS FOR THE COMPLETION OF FORM PA-W3R

EMPLOYER QUARTERLY RECONCILIATION RETURN OF INCOME TAX WITHHELD

Enter the following required fields: Employer Account ID (if none assigned, leave blank), Entity ID – Federal EIN (if none assigned, leave blank), and period ending date (1st quarter 0331YYYY, 2nd quarter 0630YYYY, 3rd quarter 0930YYYY, and 4th quarter 1231YYYY).

Enter the legal name, trade name, and business mailing address as it should appear on future correspondence.

Enter the amount withheld for each period in the appropriate payment frequen- cy column. THE REPORTED WITHHOLDING MUST BE THE ACTUAL TAX

WITHHELD, NOT THE DEPOSITS REMITTED.

Enter type of return (original or amended).

COMPLETE LINES 1 THROUGH 5

Line 1. Enter the total amount of compensation subject to PA withholding tax for the reporting quarter.

Line 2. Enter the total amount of PA withholding tax required to be withheld (or actually withheld, if higher) for the reporting quarter. (Enter tax withheld, not deposits).

Line 3. Enter the amount of PA withholding tax paid to the Commonwealth for the reporting quarter.

Line 4. If line 3 is greater than line 2, enter overpayment amount. Line 5. If Line 3 is less than line 2, enter amount due.

Make the check or money order payable to: PA Department of Revenue. Do not send cash.

Sign and date the return, include a daytime telephone number and title.

Mail this return and payment to: PA Department of Revenue, Dept. 280903,

Harrisburg, PA 17128-0903

Questions regarding the completion of this form can be directed to the Employer Tax Division at (717) 783-1488.

EMPLOYER ACCOUNT ID

ENTITY ID (EIN)

PERIOD ENDING DATE

PA-W3R (01-01)

PA DEPARTMENT

OF REVENUE

PERIOD

SEMI MONTHLY

AMOUNTS WITHHELD

1ST HALF

1ST MONTH

▲

●

2ND HALF

1ST MONTH

▲

●

1ST HALF

2ND MONTH

▲

●

2ND HALF

2ND MONTH

▲

●

PERIOD

MONTHLY

AMOUNTS WITHHELD

1ST

MONTH

▲

●

2ND

MONTH

▲

●

3RD

MONTH

▲

●

TOTAL

▲

(Enter on Line 2)

●

M M D D Y Y Y Y

BUSINESS NAME AND ADDRESS

LEGAL NAME

TRADE NAME

BUSINESS MAILING ADDRESS

CITY, STATE, ZIP

▼ LINES 1 – 5 MUST BE COMPLETED. ▼

1ST HALF
3RD MONTH						▲					●

2ND HALF
2ND HALF
3RD MONTH						▲					●

TOTAL						▲
TOTAL
(Enter on Line 2)											●

QUARTERLY AMOUNT WITHHELD.
ENTER ON LINE 2 ONLY ➡

TYPE OF RETURN	ORIGINAL	AMENDED
Original or amended. Check block. ➡

1. TOTAL COMPEN-
SATION SUBJECT	▲
TO PA TAX	▲

2. TOTAL PA WITHHOLDING TAX

3. TOTAL DEPOSITS FOR QUARTER

(Including verified overpayments)

▲ ▲

▲ ▲

▲ ▲

●

●

●

MAILCOMPLETED PA-W3RAND PAYMENTS TO: PADEPARTMENT REVENUE

DEPT. 280903 HARRISBURG, PA17128-0903

DEPARTMENT USE ONLY

4. OVERPAYMENT

(If Line 3 is greater than Line 2)

5. TAX DUE/PAYMENT	$
(If Line 3 is less than Line 2)

▲ ▲

▲ ▲

●

●

I certify that this return is to the best of my knowledge, information and belief, a full, true and correct disclosure of all tax collected or incurred during the period indicated on this return.

00019

DATE

DAYTIME TELEPHONE #

EXT. TITLE

()

SIGNATURE

PA DEPARTMENT OF REVENUE DEPT 280903

HARRISBURG PA 17128-0903

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