Payment Voucher Form - Keystone Collections Group

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Keystone Collections Group
546 Wendel Road
Irwin, PA 15642-4582
(724) 978-0300 • FAX (724) 978-0339
Name
Address
City
State
&
Zip
The $52.00 Local Services Tax is due from all individuals who are employed within the below
identified taxing jurisdictions. Federal employees and all self-reporting Individuals who perform services
of any kind or engage in occupation or professions within the stated taxing jurisdiction are required to pay
the Local Services Tax. If you have further questions regarding this tax please visit our website at
Please complete and return the LST-3 form below with your payment due no later than April 30. If
you previously paid this tax to another taxing jurisdiction or place of employment, please provide proof of
payment to this office for credit or adjustment.
You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund and
collection of local taxes by calling the above number during our normal hours of operation.
Tax Year: ___________
(please enter tax year)
Taxing Jurisdiction: ________________________________
(please enter taxing jurisdiction)
Social Security Number __________________
(please enter social security number)
1. Local Services Tax
$
2. Penalty
$
after Due Date
Make checks payable & mail to:
3. Interest
Keystone Collections Group
$
per month after Due Date
546 Wendel Road
Irwin, PA 15642
4. TOTAL DUE
$
Keystone Collections Group
546 Wendel Road
Irwin, PA 15642-4582
Local Services Tax Individual Return
(724) 978-0300 • FAX (724) 978-0339
LST-3
OFFICE COPY
Tax Year: ___________
(please enter tax year)
Taxing Jurisdiction: ________________________________
(please enter taxing jurisdiction)
Social Security Number __________________
(please enter social security number)
1. Local Services Tax
$
2. Penalty
Name
$
after Due Date
Address
City
3. Interest
State
$
&
per month after Due Date
Zip
4. TOTAL DUE
$

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