LST-Remittance-Form

Honesdale Borough 20 Local Services Tax Quarterly Remittance Form
Year
YYYY
Employers Name
Make Checks Payable to Honesdale Borough

Submit document(s) & payment(s) to 958 Main Street
Official Use Only: Date Received

MonthDayYear
Date
Amount Paid
Check
Contact Name
Phone
If exempt, has Exemption employee earned Certificateless than $12,000 Filed (X)for the year?

YesNo
Paystub or W2 provided?
Contribution Due
Upload Media Files
All forms that require payment will not be processed unless that form and payment is received at the Borough building.
Should be Empty: