Ems / Local Services Tax - Personal Return Form

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EMS / LOCAL SERVICES TAX - PERSONAL RETURN
A Local Services Tax of $52 is due per calendar year from all individuals that work in the City
of Scranton. This includes all federal and state employees and self employed individuals that perform services of
any kind or engage in any occupation or profession.
Complete and return this form with your payment due. If for some reason you already paid the tax in another
political subdivision, or at a place of employment, provide this office with proof of payment. If you desire a receipt,
include a self addressed stamped envelope.
: ________________
___________________________
Social Security Number
NAME:
___________________________
ADDRESS:
___________________________
___________________________
YEAR:
___________________________
1. Local Services Tax
$
52.00
2. LESS: Adjustments
$(_____)
(Attach proof)
3. Balance
$______
4. Penalty (1/2% per month)
$
$
5. Interest (1/2% per month)
6. Total Due
$
Current Year - Pro Rated payments are due quarterly, April 30th, July 31st, Oct. 31st, and Jan.31st
These payments are $13 if there was no tax withheld.
MAKE CHECKS PAYABLE AND REMIT TO:
COLLECTOR OF TAXES
441 WYOMING AVE.
SCRANTON, PA 18503
___________________________________________________________________
Signature
Date
I declare under the penalties provided by law that this return has been examined by me and is to the best of my
knowledge and belief true and correct.

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