Form Lst 2 - Employee'S Evidence Of Deduction Certificate - City Of Lock Haven Tax Office

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FORM LST 2, EMPLOYEE’S EVIDENCE OF DEDUCTION CERTIFICATE
KCSD#
Collector
City of Lock Haven Tax Office – LST Tax
Tax Amount Deducted $____________________
_
20 East Church Street
Lock Haven, PA 17745
Levied By:
$47.00 – City of Lock Haven
(570) 893-5621
$ 5.00 - Keystone Central School District
Employer’s Name & Address:
Account Number
SUBMITTED FOR: Employee’s Name & Address:
SS#____________________________
NAME: ________________________________________________
Year
ADDRESS:_____________________________________________
2016
CITY: __________________________ST.______ ZIP___________
*Please copy this form for additional employee’s*
FORM LST 2, EMPLOYEE’S EVIDENCE OF DEDUCTION CERTIFICATE
KCSD#
Collector
City of Lock Haven Tax Office – LST Tax
Tax Amount Deducted $_____________________
20 East Church Street
Levied By:
Lock Haven, PA 17745
$47.00 – City of Lock Haven
(570) 893-5621
$ 5.00 - Keystone Central School District
Employer’s Name & Address:
Account Number
SUBMITTED FOR: Employee’s Name & Address:
SS#____________________________
NAME: ________________________________________________
Year
ADDRESS:_____________________________________________
2016
CITY: __________________________ST.______ ZIP___________
*Please copy this form for additional employee’s*
FORM LST 2, EMPLOYEE’S EVIDENCE OF DEDUCTION CERTIFICATE
KCSD#
Collector
City of Lock Haven Tax Office – LST Tax
Tax Amount Deducted $_____________________
20 East Church Street
Lock Haven, PA 17745
Levied By:
(570) 893-5621
$47.00 – City of Lock Haven
$ 5.00 - Keystone Central School District
Employer’s Name & Address:
SUBMITTED FOR: Employee’s Name & Address:
Account Number
SS#____________________________
NAME: ________________________________________________
Year
ADDRESS:_____________________________________________
2016
CITY: __________________________ST.______ ZIP___________
*Please copy this form for additional employee’s*
FORM LST 2, EMPLOYEE’S EVIDENCE OF DEDUCTION CERTIFICATE
KCSD#
Collector
City of Lock Haven Tax Office – LST Tax
Tax Amount Deducted $_____________________
20 East Church Street
Lock Haven, PA 17745
Levied By:
$47.00 – City of Lock Haven
(570) 893-5621
$ 5.00 - Keystone Central School District
Employer’s Name & Address:
Account Number
SUBMITTED FOR: Employee’s Name & Address:
SS#____________________________
NAME: ________________________________________________
Year
ADDRESS:_____________________________________________
2016
CITY: __________________________ST.______ ZIP___________
*Please copy this form for additional employee’s*

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