Individual File Maintenance Form

Enter the information below to update your file with Berkheimer Tax Administrator.

Personal Information

First Name *

Last Name *

Identifier *

Social Security Number (last 4 digits)

Account Number (listed on form)

Social Security Number (last 4 digits)

Account Number

Phone *

Email *

Address *

Country

City

State

Zip code

Resident PSD Code *

Find the PSD Code?

PSD Code List

How long have you lived at the above address?

From *

To *

DId you move to the above address within the last 2 years? *

Yes

No

Previous Address *

Country

City

State

Zip code

Previous Address

Employer

Employer PSD Code *

The PSD Code where you work

Find the PSD Code?

PSD Code List

Employment Status *

I am my own business

I work for an employer

I currently am not working and have no earned income at this time

Does your employer withhold the Local Earned Income Tax from your pay?

No

Yes

I don't know

If you have no income at this time, please specify why:

If Other, please specify

Spouse Personal Information

If you have a spouse, complete this section.

Spouse First Name

Spouse Last Name

Spouse Identifier

Social Security Number (last 4 digits)

Account Number (listed on form)

Spouse Social Security Number (last 4 digits)

Spouse Account Number

Spouse Residency

How long has your spouse lived at the above address?

From

To

Did your spouse move to the above address within the last 2 years?

Yes

No

Spouse Previous Address

Apt, suite, etc.

Country

City

State

Zip code

Spouse Employer

Spouse Employer PSD Code

Find the PSD Code

PSD Code List

Employment Status

My spouse has their own business

My spouse works for an employer

My spouse currently am not working and have no earned income at this time

If your spouse has an employer, does the employer withhold the Local Earned Income Tax from their pay?

No

Yes

I don't know

If your spouse has no income at this time, please specify why:

If Other, please specify:

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