Form 541 - Annual Reconciliation Of Earned Income Tax (Eit) And Local Services Tax (Lst)
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1Franklin County Area Tax Bureau
443 Stanley Avenue
Chambersburg, PA 17201-3600
Telephone: 717-263-5141 Ext. 25
Annual Reconciliation of Earned Income Tax (EIT) and Local Services Tax (LST)
Tax Year:
2014
Due:
February 28, 2015
EIN:
EIT
LST
**
1 Number of W-2 forms enclosed
Total Amount of EIT withheld
2
Total EIT reported in Box 19 “Local Income Tax”
of enclosed W-2’s (
)
Attach Calculator Tape
Total Amount of LST withheld
How are you reporting the total LST withholdings? (Check one)
□
LST reported in Box 14 “Other” of enclosed W-2’s
3
(Attach Calculator Tape)
□
LST reported on enclosed listing
4 Quarter 1 Payment(s) – Ending March 31
5 Quarter 2 Payment(s) – Ending June 30
6 Quarter 3 Payment(s) – Ending September 30
7 Quarter 4 Payment(s) – Ending December 31
8 Total Quarterly Payments (Add lines 4, 5, 6, and 7)
If Line 8 EIT is greater than Line 2 EIT
9
EIT Refund Due (Subtract Line 2 from Line 8)
If Line 2 EIT is greater than Line 8 EIT
10
EIT Balance Due (Subtract Line 8 from Line 2)
If Line 8 LST is greater than Line 3 LST
11
LST Refund Due (Subtract Line 3 from Line 8)
If Line 3 LST is greater than Line 8 LST
12
LST Balance Due (Subtract Line 8 from Line 3)
Remit a check for any Balance Due on Line 10 and/or 12. You may reduce any Balance Due for one
tax by the amount of any Refund Due for the other tax.
** LST (Local Services Tax) only applies to your employees working in jurisdictions that levy the LST. Refer to our
Employer Instructions for a list of jurisdictions that levy the LST.
Signature:
____________________________________________
Date: ___________________
Print Name & Title: ___________________________________________________________________
Telephone:
_____________________
Email: ___________________________________________
Form 541
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