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Municipal And / Or School Tax Registration If you operate a business in a municipality and/or school district in which a Business Privilege and/or Mercantile Tax has been levied on gross receipts, you are required to answer the following questions in order to comply with Act 511 of the Pennsylvania State Legislature (and the law in your local taxing district). All information will be held in strict confidence. *Name Of Business: *Federal ID or Social Security Number: *Business Address or Rental Property Address: *Taxing Jurisdiction (Municipality, Borough or City Where The Business Is Located): Address To Which Forms Should Be Mailed: Name Of Contact Person: *Name Of Business Owner: *Date Business Operations Began Or Will Begin: *Telephone Number: Fax Number: *Type Of Business: If your business is currently filing the Business Privilege / Mercantile Tax with Berkheimer, please indicate your Account Number: City: State: Zip Code: City: State: Zip Code: Month: Day: Year: Email Please Tab from field to field, do not Enter.

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