Form Lst-1 - Local Services Tax
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1YEAR
Local Services Tax
1
TOTAL NUMBER OF SELF
1
TAX PERIOD
EMPLOYED INDIVIDUALS AND
EMPLOYEES REPORTED
ACCOUNT
HEREWITH
<<DISTRICT>>
NUMBER
2
GROSS AMOUNT OF TAX
2
YORK COUNTY,
(LINE 1 X TAX AMOUNT)
THRU
PA
FORM LST-1
3
PENALTY
3
DUE ON OR BEFORE
<<BUSINESS NAME>>
<<BUSINESS NAME>>
4
INTEREST (1/2% PER MONTH)
4
<<ADDRESS>>
<<ADDRESS>>
5
REFUND
5
<<CITY>>, <<STATE>> <<ZIPCODE>>
6
TOTAL INCLUDING ANY
FED
6
PENALTY AND INTEREST DUE
BUSINESS PHONE
EIN
NAME OF CONTACT PERSON
RETURN THIS COPY TO THE TAX BUREAU
AUTHORIZED
SIGNATURE
REQUIRED
DATE
I DECLARE UNDER PENALTY OF LAW THAT THE INFORMATION CONTAINED HEREIN IS
TRUE AND CORRECT.
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