Local Services Tax - Exemption Certificate - Pennsylvania Capital Tax Collection Bureau - 2013 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
COUNTY
2013 LST Tax Amount
Low Income
Amount Exempt if Low-
Amount NOT Exempt if
Taxing Jurisdiction
(combined if applicable)
Exemption Limit
Income Exemption
Low-Income Exemption
DAUPHIN COUNTY
Harrisburg City
$52.00
< $12,000
$47.00
$5.00
Highspire Bo.
$52.00
< $12,000
$52.00
$0.00
Steelton Bo.
$52.00
< $12,000
$52.00
$0.00
PERRY COUNTY
(New) Bloomfield Bo.
$52.00
< $12,000
$52.00
$0.00
Howe Twp.
$20.00
< $12,000
$20.00
$0.00
Marysville Bo.
$52.00
< $12,000
$52.00
$0.00
Newport Bo.
$52.00
< $12,000
$52.00
$0.00
Penn Twp
$52.00
< $12,000
$52.00
$0.00
Watts Twp.
$10.00
N/A
$0.00
$10.00
JUNIATA COUNTY
Fermanagh Twp.
$52.00
<$12,000
$52.00
$0.00
Susquehanna Twp.
$52.00
< $12,000
$52.00
$0.00
SOMERSET COUNTY
Boswell Boro
$40.00
<$12,000
$40.00
$0.00
Conemaugh Twp
$52.00
<$12,000
$47.00
$5.00
Jenner Twp
$10.00
<$12,000
$10.00
$0.00
Jennerstown Boro
$52.00
NONE
$47.00
$5.00
Lincoln Twp
$52.00
<$12,000
$47.00
$5.00
Paint Bo.
$52.00
< $12,000
$47.00
$5.00
Paint Twp.
$52.00
< $12,000
$47.00
$5.00
Quemahoning Twp.
$10.00
N/A
$10.00
$0.00
Scalp Level Bo.
$10.00
N/A
$0.00
$10.00
Somerset Bo.
$52.00
<$12,000
$47.00
$5.00
Summit Twp.
$52.00
<$12,000
$52.00
$0.00
Windber Bo.
$52.00
< $12,000
$52.00
$5.00
SCHEDULE II. -- CTCB DIVISION OFFICES
CAPITAL TAX COLLECTION BUREAU
CAPITAL TAX COLLECTION BUREAU
HARRISBURG DIVISION
SOMERSET DIVISION
2301 N 3RD ST
PO BOX 146
HARRISBURG PA 17110-1893
SOMERSET PA 15501
Phone: (717) 234-3217
Phone: (814) 701-2475
Fax:
(717) 234-2962
Fax: (814) 701-2318
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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