Franklin County Area Tax Bureau - Employer Annual Reconciliation (Form 541)
-INPUT SCREEN ONLY - USE THE BUTTON TO THE RIGHT OF THIS MESSAGE TO PRINT FORM --->

Franklin County Area Tax Bureau
443 Stanley Avenue
Chambersburg, PA 17201-3600
Telephone: 717-263-5141 Ext. 25

Annual Reconciliation of Earned Income Tax (EIT) and Local Services Tax (LST)

Name and Address
 
Tax Year:
 
Due Date: February 28,
 
EIN:


    EIT LST**
1 Number of W-2 forms enclosed
2 Total Amount of EIT withheld
Total EIT reported in Box 19 "Local Income Tax" of enclosed W-2's		  
3
LST Exemption listing enclosed (Form LST-E)
Available here
    
Total Amount of LST withheld
how are you reporting the total LST withholdings? (Check one)		  
LST reported in Box 14 "Other" of enclosed W-2's
    
LST reported on enclosed listing Available here
    
4 Quarterly 1 Payment(s) - Ending March 31
5 Quarterly 2 Payment(s) - Ending June 30
6 Quarterly 3 Payment(s) - Ending September 30
7 Quarterly 4 Payment(s) - Ending December 31
8 Total Quarterly Payments (Add lines 4,5,6 and 7)
9 If Line 8 EIT is greater than Line 2 EIT
EIT Refund Due (Subtract Line 2 from Line 8)		  
10 If Line 2 EIT is greater than Line 8 EIT
EIT Balance Due (Subtract Line 8 from Line 2)		  
11 If Line 8 LST is greater than Line 3 LST
LST Refund Due (Subtract Line 3 from Line 8)		  
12 If Line 3 LST is greater than Line 8 LST
LST Balance Due (Subtract Line 8 from Line 3)		  
Remit a check for any Balance Due on Line 10 and/or 12. You may reduce any Balance Due for one tax by the amount of any Refund Due for the other tax.

** LST (Local Services Tax) only applies to your employees working in jurisdictions that levy the LST. Refer to our Employer Instructions for a list of jurisdictions that levy the LST.

Signature:    MUST PRINT TO SIGN Date:    12/16/2018

Name:        Title:    

Telephone:        Email: