Form Ls-3 - Local Services Tax Personal Return - 2010

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LS-3 2010
LOCAL SERVICES TAX
CFD
PERSONAL RETURN – EMPLOYEE ONLY
CITY OF PITTSBURGH
FOR PROPER CREDIT
Rev 09/09
SOCIAL SECURITY NUMBER MUST BE ENTERED IN BOX BELOW
Amended Return ( )
Tax Return No Longer Needed ( )
Amended Return ( )
Tax Return No Longer Needed ( )
CITY ID
SOCIAL SECURITY #
SIGNATURE _____________________________________________
SIGNATURE _____________________________________________
TITLE _____________________ DATE _______________________
TAX PERIOD
QUARTER
TITLE _____________________ DATE _______________________
PHONE _________________________________________________
PHONE _________________________________________________
Due on or before
E-MAIL ADDRESS ________________________________________
E-MAIL ADDRESS ________________________________________
PREPARER’S NAME ______________________________________
PREPARER’S NAME ______________________________________
PREPARER’S PHONE ______________________________________
PREPARER’S PHONE ______________________________________
I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and
belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the
I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and
penalties provided by law.
belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the
penalties provided by law.
OMISSION OF THE ABOVE APPLICABLE INFORMATION
OMISSION OF THE ABOVE APPLICABLE INFORMATION
CONSTITUES AN INCOMPLETE RETURN
CONSTITUTES AN INCOMPLETE RETURN
Make name/address corrections above
USE BLACK INK ONLY ON THIS FORM
LOCAL SERVICES TAX IS $52.00 PER YEAR - $13.00 PER QUARTER
LOCAL SERVICES TAX
1.
2. PENALTY AND INTEREST PER MONTH 1.5% TOTAL
(If applicable)
Penalty per month 0.5% (0.005) Interest per month 1% (0.01)
3. TOTAL PAYMENT – Add lines 1 & 2
Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH
Mail to: CITY TREASURER LS-3 – PO BOX 642606 – PITTSBURGH PA 15264-2606
A $30.00 fee will be assessed for any check returned from the bank for any reason.
If you are employed within the City of Pittsburgh and your employer is NOT required or WILL NOT withhold the Local Services
Tax, and you expect to make over $12,000 in the City of Pittsburgh this year, you are required to pay the tax yourself using this
form. Failure to file will result in the imposition of a penalty and interest charge.
You should pay $13 per quarter for a total of $52. First quarter, January, February & March return due April 30. Second
Quarter, April, May & June return due July 31. Third quarter, July, August & September return due October 31. Fourth
quarter, October, November & December return due January 31.
Local Services Tax is $52.00 per person, per year, payable quarterly. Pennsylvania law limits total payment by one person to a
maximum of $52.00 per year regardless of the number of employers in a year. For information call 412-255-2510.
IF THIS FORM IS NO LONGER NEEDED, PLEASE COMPLETE THE FOLLOWING
A.
My employer is deducting the tax.
EMPLOYER_______________________________PAYROLL CONTACT PERSON_____________________
ADDRESS________________________________PHONE ________________________________________
B.
My occupation is performed outside the City limits in (Municipality)___________________________________

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