Local Services Tax - Exemption Certificate - Pennsylvania Capital Tax Collection Bureau Page 2
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2SCHEDULE I. – 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
LST Tax Amount
Amount Exempt if
Amount NOT
COUNTY
(combined if
Low Income
Low-Income
Exempt if Low-
CTCB Division Serving
Taxing Jurisdiction
applicable)
Exemption Limit
Exemption
Income Exemption
this Taxing Jurisdiction
DAUPHIN COUNTY
Harrisburg City
$52.00
< $12,000
$47.00
$5.00
Harrisburg
Highspire Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Steelton Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
PERRY COUNTY
(New) Bloomfield Bo.
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Howe Twp.
$20.00
< $12,000
$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
Penn Twp
$52.00
< $12,000
$52.00
$0.00
Harrisburg
Watts Twp.
$10.00
N/A
$0.00
$10.00
Harrisburg
JUNIATA COUNTY
Fermanagh Twp.
$52.00
<$12,000
$52.00
$0.00
Juniata
Susquehanna Twp.
$52.00
< $12,000
$52.00
$0.00
Juniata
SOMERSET COUNTY
Boswell Boro
$40.00
<$12,000
$52.00
$0.00
Somerset
Conemaugh Twp SD
$10.00
N/A
$0.00
$10.00
Somerset
Jennerstown Boro
$52.00
<$12,000
$52.00
$0.00
Somerset
Paint Bo.
$52.00
< $12,000
$47.00
$5.00
Somerset
Paint Twp.
$52.00
< $12,000
$47.00
$5.00
Somerset
Scalp Level Bo.
$10.00
N/A
$0.00
$10.00
Somerset
Somerset Bo.
$52.00
<$12,000
$47.00
$5.00
Somerset
Windber Bo.
$52.00
< $12,000
$47.00
$5.00
Somerset
SCHEDULE II. -- CTCB DIVISION OFFICES (Find the appropriate Division for a particular taxing jurisdiction in Schedule I. Above)
CAPITAL TAX COLLECTION BUREAU
CAPITAL TAX COLLECTIO
CAPITAL TAX COLLECTION BUREAU
HARRISBURG DIVISION
BUREAU
SOMERSET DIVISION
2301 N 3RD ST
JUNIATA DIVISION
PO BOX 146
HARRISBURG PA 17110-1893
4226 WILLIAM PENN HWY, STE 5
SOMERSET PA 125501
Phone: (717) 234-3217
MIFFLINTOWN PA 17059
Phone: (814) 701-2475
Fax:
(717) 234-2962
Phone : (717) 436-2796
Fax: (814) 443-6751
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 earnings for tax
year _________
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