Form Pes 4012 is the form taxpayers use to request a withholding certificate from their employer. The certificate allows taxpayers to specify the amount of income tax their employer should withhold from their wages. Taxpayers who do not submit Form Pes 4012 to their employer may have too much or too little income tax withheld from their paychecks, which could result in a tax refund or balance due when they file their taxes.
Before you decide to fill in form pes 4012, you should find out more about the type of form you'll use.
| Question | Answer |
|---|---|
| Form Name | Form Pes 4012 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | aspx, CPD, pes, cpd log |
OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS |
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Continuing professional development (CPD) activity log |
4012 |
All CPD activities and courses must be relevant to the practice of engineering or surveying and must include technical, ethical or managerial content. This form is required for tracking your CPD hours for Ohio P.E. and P.S. registration annual renewal. This form does not replace copies of your certificates of completion or other documentation required by Ohio Revised Code section 4733.151. Fifteen CPD hours are required for Ohio registration renewal. A maximum carryover of 15 CPD hours are allowed per year. For information about the Board’s CPD requirements, go to our website at www.peps.ohio.gov/ContinuingEducation.aspx.
YOUR OHIO P.E., P.S. REGISTERED NAME AS IT IS ON YOUR LICENSE |
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P.E. NUMBER |
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P.S. NUMBER |
FOR CALENDAR YEAR |
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DATE |
SPONSOR / |
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LOCATION: |
ACTIVITY TITLE, |
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CPD |
DOCUMENTATION |
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[MM/DD] |
PROVIDER |
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ADDRESS, CITY, STATE, ZIP |
DESCRIPTION |
INSTRUCTOR |
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EARNED |
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RECEIVED |
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2008 CPD |
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TOTAL |
TOTAL |
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The CPD credits listed herein are true and correct, and accurately state the professional development hours I have earned. |
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CARRIED OVER |
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2009 CPD |
CPD |
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(MAXIMUM 15) |
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EARNED |
EARNED |
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SIGNATURE |
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DATE SIGNED |
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State Board of Registration for Professional Engineers and Surveyors
50 West Broad Street, Suite 1820 • Columbus, Ohio
VOICE (614)
PES 4012 (Rev. 01/2009)