Ebensburg

Pennsylvania

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Local Services Tax – Refund

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Document Overview

This is a Local Services Tax (LST) Refund Application form from Ebensburg, Pennsylvania. It is used by residents to request a refund of Local Services Tax paid during a specific tax year. The form requires personal information, reason for refund, employment details, and supporting documentation.

Key Requirements & Instructions

Submission Rules

  • Must be completed and signed.
  • All necessary supporting documents must be attached.
  • No refund will be approved without proper documentation.
  • Submit to the tax office responsible for collecting LST in your municipality or school district.

Personal Information Required

  • Name, Address, City/State, Zip
  • Social Security Number
  • Phone Number

Reason for Refund (Check All That Apply)

  1. Overpaid by more than $1.
  2. Tax was withheld when it should have been exempted.
  3. Multiple employers — attach current pay statement from principal employer showing:
    • Employer name
    • Payroll period length
    • Amount of LST withheld
    • List all employers on reverse side.
  4. Total earned income and net profits within municipality/school district were less than $______ — attach last pay statements from all employers in that jurisdiction for prior year.
    • Self-employed? Attach PA Schedule C, F, or RK-1 for prior year.
  5. Active Duty Military Exemption — attach copy of orders directing active duty status.
  6. Military Disability Exemption — attach discharge orders + statement from U. S. Veterans Administrator declaring 100% permanent disability.

Employment Information Section

  • List all places of employment for the applicable tax year.
  • Primary employer goes under #1; secondary employers under other columns.
  • If self-employed, write “SELF” in Employer Name column.
  • For each employer, provide:
    • Employer Name, Address (including Address 2 if applicable), City/State/Zip, Municipality, Phone
    • Start Date, End Date
    • Status (Full-Time or Part-Time)
    • Gross Earnings

Confidentiality Notice

All information submitted is confidential and used only for official purposes related to collection, administration, and enforcement of the Local Services Tax.

Declaration & Signature

Applicant must declare under penalty of law that all information is true and correct.

  • Signature line
  • Date line

Form Identification

  • Form Code: LST Refund 10-07 (appears at bottom of both pages)

Notes for Applicants

  • Be thorough in listing all employers and attaching required documents.
  • Ensure income thresholds are clearly stated if claiming exemption based on low earnings.
  • Military applicants must include official documentation to qualify for exemptions.
  • Keep copies of everything submitted for your records.
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