Local Services Tax Refund Form - City Of Pittsburgh - Department Of Finance
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1CITY OF PITTSBURGH – DEPARTMENT OF FINANCE
LOCAL SERVICES TAX REFUND FORM
COMPLETE A SEPARATE REFUND FORM FOR EACH TAX YEAR
REQUESTS MAY BE DENIED IF FORM IS NOT COMPLETED CORRECTLY
REFUND REASON CODES (CIRCLE ONE)
ME
Multiple Employers
The $52 Local Services Tax was withheld by more than one employer in a tax year.
Your second employer must be located in the City of Pittsburgh. Fill in the required
information. Attach copies of your W-2’s and last pay stubs from all employers for the
tax year showing the total amount of tax that was withheld.
UT
Under $12,000
Your total earned income for the year was less than $12,000 in the City of Pittsburgh.
Your employer(s) must be located in the City of Pittsburgh. Fill in the required
information. Attach copies of your W-2’s and last pay stubs from all Pittsburgh
employers for the tax year showing the total amount of tax that was withheld.
●
If you did not work in the City of Pittsburgh and the $52 Local Services Tax was withheld in error by
your employer, you need to send a letter of explanation from your employer on the company letterhead.
In addition, you need to provide proof of payment of the Local Services Tax to another municipality.
●
Employers that need a refund must file an amended LS-1 tax return and attach a letter of explanation.
●
Refunds for the current year may be requested directly from your employer. The employer may then make
an adjustment on their next quarterly LS-1 tax return to the City of Pittsburgh.
●
In accordance with Act 50, the Local Taxpayers Bill of Rights, a taxpayer may file a written request for a refund on the
prescribed form within 3 years of the due date of the tax.
REQUIRED INFORMATION
Principal Employer
Location of Employment
Phone
Second Employer
Location of Employment
Phone
Third Employer
Location of Employment
Phone
Social Security Number
Refund Amount Requesting
Tax Year
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 penalties provided by law.
PRINT NAME ____________________________________SIGNATURE______________________________________
ADDRESS _______________________________________________________________________________________
CITY/STATE/ZIPCODE ________________________________________PHONE_______________________________
For questions call 412-255-8629 or 412-255-2510
Mail to: City of Pittsburgh – LST Refund Request – 414 Grant St Rm 207– Pittsburgh PA 15219
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