PO BOX 25156
LEHIGH VALLEY, PA 18002-5156
ACCOUNT NO. FEDERAL EIN:
Quarter ______ Year ______
JURISDICTION:
PSD:
BUSINESS LOCATION:
Payable to: HAB-LST
BERKHEIMER, PO BOX 25156, LEHIGH VALLEY, PA 18002-5156
LST-1 Local Services Tax Employer Return
1.Total of SD Only Payments
2. Number of Exemptions Enclosed
3. Number of Employees Reported
4. Amount Withheld
5. Discount (line 4 x )
6. Net Amount Due (line 4-line 5)
7. Penalty (line 6 x 0.05 ) after due date
8. Interest (line 6 x 0.005 ) per month after due date
9. Total Penalty & Interest (line 7 + line 8)
10. Total of Check Enclosed (line 6+line 9)
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*LST1*
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WEB
THIS FORM MUST BE FILED AND RETURNED EACH QUARTER
You are entitled to receive a written explanation of your rights with regard to the audit,
appeal, enforcement, refund and collection of local taxes by calling Berkheimer at
610-599-3182. Or, you can visit our website at www.hab-inc.com. If Berkheimer is not
the appointed tax hearing officer for your taxing district, you must contact your taxing
district about the proper procedures and forms necessary to file an appeal.
Name
Address
City
State
ZIP
File Online: www.berk-e.com
l Your cancelled check is sufficient proof of payment.
l Make any corrections on this form to Name, Address, and Business Location.
l There will be an additional fee assessed for returned payments.
l There will be an additional fee assessed if no payment is enclosed for tax
due at time of filing.
Do you expect to pay taxable wages next year?
