LOCAL SERVICES TAX 
LS-3  2021                     PERSONAL RETURN – EMPLOYEE ONLY 
                                                    CITY OF PITTSBURGH 

                                                                                                                                                                                                                    Rev 12/20 
    CITY ID        SOCIAL SECURITY #                Amended Return 

                                                    SIGNATURESIGNATURE _____________________________________________                                                                                                                                              
    QUARTER 
                                                    TITLE TITLE _____________________ DATE   DATE _______________________ 

Due on or before                                    PHONEPHONE _________________________________________________ 
                           
                                                    E-MAILE-MAIL ADDRESS   ADDRESS                        ________________________________________                                                                                                                
                                                    PREPARER’SPREPARER’S NAMENAME   ______________________________________                                                                                                                                        
                                                    PREPARER’SPREPARER’S PHONEPHONE                                        ______________________________________ 
                                                    II herebyhereby certify,certify, swearswear andand averaver thatthat allall statementsstatements hereinherein areare truetrue andand correctcorrect toto thethe bestbest ofof mymy knowledgeknowledge andand 
                                                    belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the 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. penalties provided by law. 
                                                                    OMISSION OF THE ABOVE APPLICABLE INFORMATION 
                                                                    OMISSIONCONSTITUESOF THE ABOVEANAPPLICABLEINCOMPLETEINFORMATIONRETURN 

USE BLACK INK ONLY ON THIS FORM- DO NOT STAPLE ANYTHING TO THIS FORM 

If this is an annual return please check this box 

       LOCAL SERVICES TAX IS $52.00 PER YEAR - $13.00 PER QUARTER 

1. LOCAL SERVICES TAX AMOUNT

2. INTEREST – (Interest per month 1% (0.01) )

3. PENALTY – (Penalty per month 0.5% (0.005) )

4. TOTAL AMOUNT DUE – (Add lines 1 through 3)

       Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH 
       Mail to:  CITY TREASURER LS-3 – 414 GRANT ST – PITTSBURGH PA 15219-2476 
          A $30.00 fee will be assessed for any check returned from the bank for any reason. 

If you are employed within the City of Pittsburgh and your employer is NOT required or WILL NOT withhold the 
Local Services Tax, and you expect to make over $12,000 in the City of Pittsburgh this year, you are required to pay 
the tax yourself using this form. Failure to file will result in the imposition of a penalty and interest charge. 
You should pay $13 per quarter for a total of $52. Local Services Tax is $52.00 per person, per year, payable 
quarterly. Pennsylvania law limits total payment by one person to a maximum of $52.00 per year regardless of the 
number of employers in a year. 

                 First quarter (January, February, and March) return is due April 30. 
                 Second Quarter (April, May, and June) return is due July 31. 
                 Third quarter (July, August, and September) return is due October 31. 
                 Fourth quarter (October, November, and December) return is due January 31. 

                               FOR ASSISTANCE CALL 412-255-2525 
Do you work for a business now filing your taxes or did you relocate? If YES, a CHANGE IN BUSINESS 
    STATUS FORM must be completed and returned for processing. Form(s) can be downloaded at 
               www.pittsburghpa.gov/finance or call 412-255-2525 to request the form.