LST-1 Local Services Tax Employer Return 
                                                                                                                                      *LST1*

     PO BOX 25156
     LEHIGH VALLEY, PA 18002-5156

     File Online: www.berk-e.com

Name
Address
City
State
ZIP

                                                                             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.

Payable to:  HAB-LST                                                         Do you expect to pay taxable wages next year? 
BERKHEIMER, PO BOX 25156, LEHIGH VALLEY, PA 18002-5156
                                                                             1.Total of SD Only Payments
                                                                                                                                      , ,
ACCOUNT NO.                               FEDERAL EIN:                                                                                      .
                                                                             2. Number of Exemptions Enclosed
Quarter ______  Year ______ 
                                                                             3. Number of Employees Reported 
JURISDICTION:
PSD:
BUSINESS LOCATION:                                                           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) 
                         WEB                                                                                                          , ,   .

l Your cancelled check is sufficient proof of payment.                       10. Total of Check Enclosed (line 6+line 9)              , ,   .
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.                                                     THIS FORM MUST BE FILED AND RETURNED EACH QUARTER