Application For Per Capita and / or Occupation Exoneration

Before applying for an exoneration, CLICK HERE to see if your locality has a special form.

Taxpayer Information

Exemption Request Information

Tax Year Instructions

What is the Tax Year you are applying to be placed on the list of taxpayers exempted from payment of the per capita and/or occupation tax for the year.

Reason Instructions

What is the Reason you are applying to be placed on the list of taxpayers exempted from payment of the per capita and/or occupation tax?

I hereby state that the above facts are true and correct, and that I understand I may be subject to the penalties contained in the Pennsylvania Crimes Code for un-sworn falsifications to legal authorities if any of the above statements are incorrect.