2021 TAX YEAR BOROUGH OF PITCAIRN Mercantile Tax Return  Account #  READTHOROUGHLY BEFORE COMPLETING FORM  IF YOU DO NOT HAVE AN ACCOUNT, SUBMIT WITH YOUR RETURN AI REGISTRATION FORM. INCOMPLETE FORMS OR MISSING ACCOUNT # MAY BE TREATED AS FAILURE TO FILE RETURN.  TAX: IDENTIFICATION# Description of Business Activity Check one: Business operated as  #ofemployees working in Pitcairn  individua/Propnetor  Partnership  Corporation or LLC NAME ADDRESS CITY/ST/ZIP Retail $  Wholesale  1) TOTAL GROSS RECEIPTS/VOLUME (Schedule A) I$ 2) EXCLUSIONS (complete Schedule B) 3) TAXABLE GROSS RECEIPTS (Line 1-I Line 2) 4) TAX RATE 5) TAX: DUE (Line 4 xl Line 5) 6) INTEREST AND PENALTY (1%ar mo)(Line 5x%) 7) ADD 2021 LICENSE FEE IF NOT ALREADY PAID 8) TOTAL DUE (Line 5 +L Line 64 + Line 7)  0.001  0.0015  Check # Signature: PRINT NAME HERE: Phone #  Total Paid = COMBINE LINE 8 COLUMNS $  Job Title:  Date Fax #  Email:  Submit a copy of documentation used to obtain amount reported on line 1 and 2  SCHEDULE. A LINE 1:  HOW TO REPORTTOTAL GROSS REVENUE/VOLUME  A1 Ifconducting business from a PITCAIRN location the entire 2020 year, file by April 15, 2021 Report total gross receipts generated by the PITCAIRN location for the 2020 calendar year on line 1 Use calendar year receipts even ifthe business has a year end other than December 315t A2 Ifbusiness commenced in PITCAIRN after January 1 2020, a return is due April15,2021  Multiply your first 30 days gross receipts from 2020: X 121 months.  $  x12months = $  report on Line 1  A3 Ifbusiness commenced in PITCAIRN during 2021, The return is due 40 days from the start date  multiply the first 30 days receipts by the remaining months. 2021 START DATE Example: Ifs start date is January 12, use. Jan 121 to Feb 11 gross receipts X the remaining months Ifthe 30 days receipts is $100x remaining 11.67 months = $1,167. March 31,2021 would bet the due date. A4 Ifbusiness in PITCAIRN is temporary or seasonal, file return within 7 days from completion date. Report your 2021 ACTUAL calendar year gross receipts without deductions. Report on Line 1 Examples of documentation may include contract progress billing statements, receipt vouchers, etc.  $  30 daysx  months + fractions -$  report on Line1 1  Start Date  Completion Date  Page 1of2    SCHEDULE B: EXCLUSIONS FROM GROSS RECEIPTS - Report total on Line 2 of page one  Wholesale $  Retail  B1) Interstate transactions attach breakdown B2) Manufacturing attach federal or PA exemption B3) Articles of own growth B4) Sales returns and allowances-ifi included in gross receipts B5) Trade discounts or Service Receipts B6) Excise tax /federal tax on admissions/dues B7) Liquid fuels tax gasoline only B8) Receipts of entity categorized as aj public utility B9) Commissions paid by a broker to another broker B10) Tax receipts collected as an agent for USA orl PA B12) Receipts attributable to locations outside of Pitcairn  I$  B11) Beer distributor  attach breakdown and list addresses  PITCAIRN COUNCIL AUTHORIZED THE MUNICIPALITY OF MONROEVILLETOCOLLECT MERCANTILE TAX: FOR THE BOROUGH OF PITCAIRN BEGINNINGJANUARY 1,2006.  INSTRUCTIONS:  Line 1a and 2: Complete and insert Gross Receipts / Volume from Schedule A and B Submit a copy of documentation used to obtain amount reported on line 1 and line 2 Line 6 = 1% per month is a combined rate ofi interest @ 6% per annum and penalty @ %% per Line 7 = $5 per location in Pitcairn when reporting receipts for only one tax type. $10: for each location reporting gross volume or receipts from wholesale and retail activities. Checks should be made payable to Municipality ofl Monroeville." Post mark at the post office BY APRIL15, 2021. Submit the return with appropriate payment and documentation. Due Date is different ift business commenced in Pitcairn in current year. Mail to: Business Tax Office 2700 Monroeville Blvd Monroeville, PA 15146-2388. Direct Inquiries to: montn@momoeylepaus Phone 4123175080 Facsimile 412 856 1054 ntps/www.monroeyile.pa.uslaxax forms.htm provides detailed information for Pitcairn Tax LOCAL: LAW DOES NOT PROVIDE FOR AN EXTENSION OF TIME TOI FILE. Itis recommended you file a tentative return WITH payment then amend the return ifnecessary.  Allocate amounts between applicable columns.  month.  Ordinances since this return does not contain all details and disclosures.  Any unpaid balance must include interest & penalty.  Definition oft tax type:  WHOLESALERETAL = Mercantile: Sale of tangible goods, commodities, food, beverages, or a place of amusement Examples include: merchandise, theaters, amusement parks, bowling alleys, and pin ball machines TAXPAYERS BILL OF RIGHTS DISCLOSURE STATEMENT: You are entitled tor receive a written explanation ofy yourr rights with regard tot the audit, appeal, enforcement, refund and collection of local taxes from itps/www.monroeviepa.us/axlx forms.htm or the Tax Office.  Page 2of2