Form Ls-3 - Local Services Tax Personal Return

LS-3 2008

LOCAL SERVICES TAX

CFD

PERSONAL RETURN – EMPLOYEE ONLY

CITY OF PITTSBURGH

FOR PROPER CREDIT

Rev 09/07

SOCIAL SECURITY NUMBER MUST BE ENTERED IN BOX BELOW

Amended Return ( )

Tax Return No Longer Needed ( )

Amended Return ( )

Tax Return No Longer Needed ( )

CITY ID

SOCIAL SECURITY #

SIGNATURE _____________________________________________

TITLE _____________________ DATE _______________________

TAX PERIOD

QUARTER

TITLE _____________________ DATE _______________________

PHONE _________________________________________________

Due on or before

E-MAIL ADDRESS ________________________________________

PREPARER’S NAME ______________________________________

PREPARER’S PHONE ______________________________________

I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and

belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the

I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and

penalties provided by law.

belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the

penalties provided by law.

OMISSION OF THE ABOVE APPLICABLE INFORMATION

CONSTITUTES AN INCOMPLETE RETURN

CONSTITUES AN INCOMPLETE RETURN

Make name/address corrections above

USE BLACK INK ONLY ON THIS FORM

LOCAL SERVICES TAX IS $52.00 PER YEAR - $13.00 PER QUARTER

LOCAL SERVICES TAX

2. PENALTY AND INTEREST PER MONTH 1.5% TOTAL

(If applicable)

Penalty per month 0.5% (0.005) Interest per month 1% (0.01)

3. TOTAL PAYMENT – Add lines 1 & 2

Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH

Mail to: CITY TREASURER LS-3 – PO BOX 642606 – PITTSBURGH PA 15264-2606

A $30.00 fee will be assessed for any check returned from the bank for any reason.

If you are employed within the City of Pittsburgh and your employer is NOT required or WILL NOT withhold the Local Services

Tax, and you expect to make over $12,000 in the City of Pittsburgh this year, you are required to pay the tax yourself using this

form. Failure to file will result in the imposition of a penalty and interest charge.

You should pay $13 per quarter for a total of $52. First quarter, January, February & March return due April 30. Second

Quarter, April, May & June return due July 31. Third quarter, July, August & September return due October 31. Fourth

quarter, October, November & December return due January 31.

Local Services Tax is $52.00 per person, per year, payable quarterly. Pennsylvania law limits total payment by one person to a

maximum of $52.00 per year regardless of the number of employers in a year. For information call 412-255-2510.

IF THIS FORM IS NO LONGER NEEDED, PLEASE COMPLETE THE FOLLOWING

My employer is deducting the tax.

EMPLOYER_______________________________PAYROLL CONTACT PERSON_____________________

ADDRESS________________________________PHONE ________________________________________

My occupation is performed outside the City limits in (Municipality)___________________________________

Form Ls-3 - Local Services Tax Personal Return - 2008

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