Local Services Tax Form - Refund Application
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2BERK EIT BUREAU
920 VAN REED RD, WYOMISSING, PA 19610
610-372-8439 TOLL FREE 1-855-372-8439 FAX 610-372-1102
EMAIL:
LOCAL SERVICES TAX - REFUND APPLICATION
Tax Year
:; A copy of this application for a refund ofthe Local Services Tax (LST), and all necessar supporting
Documents, must be completed and presented to the tax offce charged with collecting the Local Services
Tax.
:; This application for a refud of
the Local Serices Tax must be signed and dated.
:; No refund wil be approved until proper documents have been received.
Taxpayer Name:
Address:
City/State:
Soc. Sec #:
Phone#:
Zip:
REASON FOR REFUND - CHECK ALL THAT APPL X
1.
I overpaid by more than $1.00. Amount of
refud requested $
Please attach a copy of your final or year-end pay statements from all employers who
withheld the tax.
2.
I had the tax withheld when it should have been exempted.
3.
MULTIPLE EMPLOYERS: Please attach a copy of
your final or year-end pay statements
from your employers who withheld the tax. The pay statements must show the name of the
employer, the length of
the payroll period and the amount of
Local Services Tax witheld.
Please list all employers on the reverse side of this form.
4.
TOTAL EARED INCOME AN NET PROFITS FROM ALL SOURCES WITHIN
(municipality or school district) WAS
LESS THAN $ : Please attach a copy of all of your last pay statements
from all employers within the political subdivision for the year prior to the fiscal year for
which you are requesting to be exempted from the Local Serices Tax.
If you are self-employed, please attach a copy of your P A Schedule C, F, or RK -1 for the
year prior to the fiscal year for which you are requesting to receive a refud of the Local
Services Tax.
5.
ACTIVE DUTY MILITARY EXEMPTION: Please attach a copy of
your orders
directing you to active duty status.
6.
MILITARY DISABILITY EXEMPTION: Please attach a copy of
your discharge orders
and a statement from the United States Veterans Admnistration or its successor declaring
your disabilty to be a total one hundred percent pernent disability.
Tax Offce: Berks EIT Bureau
Address: 920 Van Reed Road
City/State: Wyomissing, PA
Phone: 610-372-8439 Toll Free: 1-855-372-8439
Zip: 19610
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