Application For Exemption From The Local Services Tax - Pennsylvania Capital Tax Collection Bureau - 2008 Page 2

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SCHEDULE I. – 2008 LOW-INCOME EXEMPTION INFORMATION ►HOW TO USE: Look first for the MUNICIPALITY in which
your occupation is located, If it is not listed, look for the SCHOOL DISTRICT in which your occupation is located.
A
B
C
D
E
F
2008 LST Tax
Amount Exempt if
Amount NOT
COUNTY
Amount (combined
Low Income
Low-Income
Exempt if Low-
CTCB Division Serving
Taxing Jurisdiction
if applicable)
Exemption Limit
Exemption
Income Exemption
this Taxing Jurisdiction
CUMBERLAND COUNTY
Big Spring SD
$10.00
N/A
$0.00
$10.00
Carlisle
Carlisle Bo.
$52.00
< $12,000
$52.00
$0.00
Carlisle
Dickinson Twp.
$52.00
< $12,000
$52.00
$0.00
Carlisle
Hopewell Twp.
$10.00
N/A
$0.00
$10.00
Carlisle
Mount Holly Springs Bo.
$52.00
< $12,000
$52.00
$0.00
Carlisle
Newville Bo.
$10.00
N/A
$0.00
$10.00
Carlisle
North Middleton Twp.
$52.00
< $12,000
$52.00
$0.00
Carlisle
Shippensburg Area SD
$10.00
N/A
$0.00
$10.00
Carlisle
Shippensburg Bo.
$52.00
< $12,000
$47.00
$5.00
Carlisle
Shippensburg Twp.
$52.00
< $12,000
$47.00
$5.00
Carlisle
South Middleton SD
$10.00
N/A
$0.00
$10.00
Carlisle
South Newton Twp.
$35.00
< $12,000
$30.00
$5.00
Carlisle
Southampton Twp.
$10.00
N/A
$0.00
$10.00
Carlisle
DAUPHIN COUNTY
Harrisburg City
$52.00
< $12,000
$47.00
$5.00
Harrisburg
Highspire Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Lower Paxton Twp.
$52.00
< $12,000
$52.00
$0.00
Central Dauphin
Steelton Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Swatara Twp.
$52.00
< $12,000
$52.00
$0.00
Central Dauphin
West Hanover Twp.
$52.00
< $12,000
$52.00
$0.00
Central Dauphin
FRANKLIN COUNTY
Shippensburg Area SD
$10.00
N/A
$0.00
$10.00
Carlisle
Shippensburg Bo.
$52.00
< $12,000
$47.00
$5.00
Carlisle
PERRY COUNTY
Bloomfield Bo.
$25.00
< $12,000
$25.00
$0.00
Harrisburg
Howe Twp.
$20.00
N/A
$20.00
$0.00
Harrisburg
Marysville Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Newport Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
(New) Bloomfield Bo.
$25.00
< $12,000
$25.00
$0.00
Harrisburg
Penn Twp.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Watts Twp.
$10.00
N/A
$0.00
$10.00
Harrisburg
SCHEDULE II. -- CTCB DIVISION OFFICES (Find the appropriate Division for a particular taxing jurisdiction in Schedule I. above
[Columns A & F] & match to appropriate CTCB Division below)
CAPITAL TAX COLLECTION BUREAU
CAPITAL TAX COLLECTION BUREAU
CAPITAL TAX COLLECTION BUREAU
CARLISLE DIVISION
CENTRAL DAUPHIN DIVISION
HARRISBURG DIVISION
19 S HANOVER ST STE 102
425 PRINCE ST
2301 N 3RD ST
CARLISLE PA 17013-3336
HARRISBURG PA 17109-1734
HARRISBURG PA 17110-1893
Phone: (717) 243-3725
Phone: (717) 545-2791
Phone: (717) 234-3217
Fax:
(717) 243-9224
Fax:
(717) 545-3028
Fax:
(717) 234-2962
SCHEDULE III. – COTERMINOUS EMPLOYER INFORMATION – List all places of employment for the applicable tax year. List
your PRIMARY EMPLOYER under # 1 below and your secondary employers under the other columns. If self-employed, enter
SELF in the “Employer Name” Row. If you need to list more than 3 employers use an additional Exemption Form & change the
numbers of the employers listed to 4., 5, etc.
1. Primary Employer
2.
3.
Employer Name
Street Address 1
Street Address 2
City, State & Zip Code
Municipality
Phone
Start Date
Status (Full or Part Time)
Expected 2008 Earnings

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