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85813. 3 Short Form 11/18/14 LANCASTER COUNTY TAX COLLECTION BUREAU 1845 William Penn Way Lancaster PA 17601 717/569-4521 LOCAL SERVICES TAX EMPLOYEE WITHHOLDING EXEMPTION CERTIFICATE for use where the Bureau collects LST Tax Year This application for exemption from withholding of local services tax and supporting documents must be completed signed and presented to employer AND the Bureau.

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