GREGG TOWNSHIP, UNION COUNTY BUSINESS NAME ______________________________

LOCAL SERVICES TAX FEDERAL EIN# ______________________________

EMPLOYERS FORM

LOCAL SERVICES TAX (EMST)

Make checks payable to: Gregg Township

18084 Russell Rd

BILL TO: PRINT BUSINESS NAME & ADDRESS BELOW Allenwood, PA 17810

Number of employees/owners subject to tax ________________

*Listing of name and address must be attached

Tax Payment ________________

Interest/Penalty 1% per month after due date________________

TOTAL PAYMENT SUBMITTED _______________

Quarterly Due Dates: 1st=4/30 2nd=7/31 3rd=10/31 4th=1/31

I hereby certify that the information contained in this return is true and correct to the best of my knowledge.

Signature_________________________________ Date__________________________________

DIRECT INQUIRIES TO: Gregg Township, 18084 Russell Rd, Allenwood, PA 17810

Phone-570-538-5499; fax-570-538-9438; or email

Taxpayer Bill of Rights: You are entitled to receive a written explanation of your rights with regard to the audit, appeal, enforcement, refund, and

Collection by contacting the tax office.

Definition: This is a tax on all who are employed in Gregg Township, regardless of where they reside. An employee who is compensated $12,000.00 or less gross compensation in the Year 2013, may request a refund of the LST tax by providing proof of compensation at year’s end. Likewise, valid proof of payment of the LST tax to another municipality will be required to eliminate the deduction from payroll.

Tax: $52.00 per person per calendar year.

Due Date: Due quarterly on dates listed above.

Interest/Penalty: If for any reason any tax is not paid when due, interest at the rate of 6% per year on the amount of unpaid tax and an additional penalty of ½ of 1% of the amount of the unpaid tax shall be added and collected.

Please make a copy for your records.