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Municipal And School Tax Registration If you employ one or more persons in a taxing jurisdiction that is administered by Berkheimer and have not already registered with our company as an employer, please 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. *Trade Name: *Federal Employer ID Number: *Physical Business Address: *Taxing Jurisdiction Where The Business Is Located / Employees Physically Work: *Forms Address (Address Forms Should Be Mailed To): *Name Of Payroll Contact: *Name(s) Of The Business Owner(s): *Date Business Operations Began Or Will Begin: *Business Number: Business Fax Number: *Type Of Business: City: State: Zip Code: City: State: Zip Code: Month: Day: Year: *Business Email *Number Of Employees Please include both full and part-time. The Taxing Jurisdiction consists of a municipality (boro, city, township), school district & county) Please Tab from field to field, do not Enter.

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