Complete Pennsylvania Form Rev-1667, W-2 Transmittal. Use the information on Forms W-2 to complete the report. The wages paid and the Pennsylvania tax withheld for the first three quarters are: Quarter Wages Tax Withheld 1st $34,088.75 $1,046.52 2nd $45,535.62 $1,397.94 3rd $62,600.20 $1,921.83 Hint: 4th quarter's earnings total does not include payments to an estate. If an amount is zero, enter "0". pennsylvania DEPARTMENT OF REVENUE START REV-1667 (AS) 12-17 YEAR 2 0 - - EMPLOYER ACCOUNT ID 0 0 0 0 3 3 0 0 ENTITY ID (EIN) 0 0 0 0 0 0 6 6 0 Part I RECONCILIATION 1a Number of W-2 forms attached fill in the blank 1 12 1b Number of 1099 forms with PA withholding fill in the blank 2 0 2 Total compensation/distribution subject to PA withholding $fill in the blank 3 3 PA personal income tax withheld $fill in the blank 4 DUE DATE JANUARY 31 2 0 - - ANNUAL WITHHOLDING RECONCILIATION STATEMENT BUSINESS NAME AND ADDRESS LEGAL NAME GLO-BRITE PAINT COMPANY TRADE NAME ADDRESS 2215 SALVADOR STREET CITY, STATE, ZIP PHILADELPHIA, PA 19175-0682 DO NOT SEND PAYMENT WITH THIS FORM. Part II ANNUAL RECONCILIATION Wages/distribution paid subject to PA withholding PA tax withheld 1st Quarter fill in the blank 5 34,088.75 fill in the blank 6 1,046.52 2nd Quarter fill in the blank 7 45,535.62 fill in the blank 8 1,397.94 3rd Quarter fill in the blank 9 62,600.20 fill in the blank 10 1,921.83 4th Quarter fill in the blank 11 fill in the blank 12 TOTAL fill in the blank 13 fill in the blank 14