REV-419

EMPLOYEE'S NONWITHHOLDING APPLICATION CERTIFICATE 2024

SECTION II EXEMPTION INFORMATION

I claim exemption from withholding because:

 a. I qualified for Tax Forgiveness of my PA personal income tax liability last year, and had a right to a full refund of all income tax withheld and/or I expect to qualify for Tax Forgiveness of my PA personal income tax liability this year and expect to have a right to a full refund of all income tax withheld.

 b. I declare I am a resident of the reciprocal state checked below:

 INDIANA  MARYLAND  NEW JERSEY  OHIO  VIRGINIA  WEST VIRGINIA

and that pursuant to the reciprocal tax agreement between that state and PA, I claim an exemption from withholding of PA personal income tax and authorize my employer to withhold income tax for my resident state on compensation paid to me in the Commonwealth of Pennsylvania.

 c. I certify I am a legal resident of the state of ____________ and am not subject to Pennsylvania withholding because I meet the requirements set forth under the Servicemembers Civil Relief Act, as amended, and as set forth in revised Personal Income Tax Bulletin 2010-01.


How much do you earn per paycheck?


You must enter in a value greater than zero (0) above to continue!



Do you have any pre-tax deductions withheld from your paycheck?



How much total pre-tax deductions are withheld from your paycheck?




Estimated Pennsylvania State Taxes per check are:




**The above number is an estimation and should only be used as a reference point. Questions regarding the amounts you are paid, deducted, or taxed should all be brought to your employer for further clarification. Workforce 2080 provides these estimations to assist employees and employers determine a rough estimation of what taxes, payments, or deductions *could* be. These estimations should not be construed as implict or explicit guarantees in any way. Many factors come into play, such as rounding of figures in Payroll Software, errors in the submission through this portal etc. Workforce 2080 assumes no risk with these estimations and provides these tools to help educate the general population. All users who use these products and estimators outside of their intended use assume risk when used outside of the scope of educational and general knowledge.

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Last Updated on 5/18/2024 @ 12:00 PM CDT