The Form REV-419, known officially as the Employee’s Nonwithholding Application Certificate, serves a crucial purpose in managing Pennsylvania personal income tax withholding for employees. This form allows individuals who anticipate no income tax liability for the current or following year to request exemption from withholding. It is designed to address situations varied in nature, including those under specific tax provisions or reciprocity agreements with neighboring states. Eligibility extends to individuals who did not incur a state income tax liability in the previous year and expect the same for the current year, including service members covered by the Servicemember Civil Relief Act (SCRA) and residents of reciprocal states like Indiana, Maryland, New Jersey, Ohio, Virginia, and West Virginia. The responsibility of employees filling out the REV-419 extends to annual submission unless their state of residence changes, with requirements for notification of changes that might affect their eligibility. Employers, on receiving the completed form, undertake the obligation not to withhold Pennsylvania income tax if criteria are met, or alternatively, withhold taxes for the employee's state of residence in case of reciprocity. The Pennsylvania Department of Revenue plays a supervisory role, ensuring compliance and proper tax withholding practices based on the information provided in these submissions. This introduction not only sets the landscape for understanding the operation and implications of Form REV-419 but also underscores its significance in the context of state taxation and interstate employment relations.
| Question | Answer |
|---|---|
| Form Name | Form Rev 419 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | pa rev 419, form rev 419, rev 419 ex form 2018, pennsylvania rev 419 |
4190010101
Employee’s Nonwithholding
Application Certificate
PA DEPARTMENT OF REVENUE |
20 |
OFFICIALUSE ONLY
Purpose. Complete Form
Note: Unless the state of residence changes, residents of the reciprocal states listed in the nextparagraphdonotneedtorefilethisappli- cation every year.
Who is Eligible for Nonwithholding? You may be entitled to nonwithholding of PA per- sonalincometaxifyouincurrednoliabilityfor income tax the preceding tax year and/or you anticipate that you will incur no liability for income tax during the current tax year, according to the Special Tax Provisions of section 304 of the Tax Reform Code, the Servicemember Civil Relief Act (SCRA) or as a resident of the reciprocal state of Indiana, Maryland, New Jersey, Ohio, Virginia or West Virginia and your employer agrees to withhold the income tax from that state.
WhentoClaim?Filethiscertificatewithyour employer as soon as you determine you are entitledtoclaimnonwithholding.Youmustfilea certificateeachyearyouareeligible(seeNote above for an exception). If you are employed by more than one employer you must file a separate
Responsibilities of Employee. You must |
and accompanying attachments to the PA |
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revoke this certification within 10 days from |
DEPARTMENTOFREVENUE,BUREAUOFBUSI- |
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the day you anticipate you will incur PA per- |
NESS TRUST FUND TAXES, PO BOX 280904, |
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sonal income tax liability for the current tax |
HARRISBURG, PA |
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year.Todiscontinueorrevokethiscertification, |
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you have reason to believe this certificate |
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submitnotificationinwritingtoyouremployer. |
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is incorrect; |
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Claimants who qualify for complete Tax |
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2. |
thePAtaxablegrosscompensationofany |
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Forgiveness under section 304 of the Tax |
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employee who claimed either exemption |
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Reform Code must file a |
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fromnonwithholdingaorbbelowexceeds |
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Personal Income Tax Return, and Schedule SP |
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$1,625 for any quarter; |
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toclaimTaxForgivenesseveniftheyareeligi- |
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3. |
the employee claims an exemption from |
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ble for nonwithholding. |
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withholding on the basis of residence in a |
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Under the SCRA, as amended by the Military |
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reciprocal state (Indiana, Maryland, New |
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Spouses Residency Relief Act, you may be |
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Jersey, Ohio, Virginia or West Virginia) |
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exempt from PA personal income tax on your |
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and therefore, you agree to withhold |
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wages if (i) your spouse is a member of the |
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incometaxoftheemployee’sstateofres- |
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armed forces present in PA in compliance with |
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idence; or |
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militaryorders;(ii)youarepresentinPAsolely |
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the employee claims an exemption from |
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to be with your spouse; and (iii) you and your |
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withholding under the SCRA as amended |
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spouse both maintain the same domicile |
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by the Military Spouses Residency Relief |
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(stateresidency)inanotherstate.Ifyouclaim |
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Act. |
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exemption under the SCRA, enter your state |
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of domicile (legal residence) on Line d below |
Department’s Responsibility. Upon receipt |
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and attach a copy of your spousal military |
of any exemption application, the department |
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identification card and your spouse’s current |
will make a determination and notify the |
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military orders to form |
employer if a change is required. If the |
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ResponsibilitiesofEmployer. |
department disapproves the application, the |
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employer must immediately commence with- |
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If you agree not to withhold PA tax because |
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holding at the regular rate. Once a certificate |
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your employee is a resident of a reciprocal |
is revoked by the department, the employer |
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state,youmustwithholdtheotherstate’stax. |
must send any new application received from |
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the employee to the department for approval |
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required to submit a copy of this certificate |
before implementing the nonwithholding. |
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Please print or type. A
Employee name: first, middle initial, last
Social Security Number Telephone Number
Street Address City, State, ZIP
Tax Year (not necessary if checking Box c below)
I claim exception from withholding because I do not expect to owe Pennsylvania personal income tax due to the reason(s) checked below:
a.Last year I qualified for Tax Forgiveness of my PA personal income tax liability and had a right to a full refund of all income tax withheld.
b.This year I expect to qualify for Tax Forgiveness of my PA personal income tax liability and expect to have a right to a full refund of all income tax withheld.
c.I declare I am a resident of the reciprocal state checked below:
INDIANA |
MARYLAND |
NEW JERSEY |
OHIO |
VIRGINIA |
WEST VIRGINIA |
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and that pursuant tothe reciprocaltax agreementbetween that stateandPA, I claiman exemption from withholdingof PA personal income tax |
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and authorize my employer to withhold income tax for my resident state on compensation paid to me in the Commonwealth of Pennsylvania. |
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d. I certify I am a legal resident of the state of |
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and am not subject to Pennsylvania withholding because I meet the |
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requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act. |
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Under penalties of perjury, I certify that I did not incur any Pennsylvania personal income tax liability during the preceding tax year and/or I do not expect |
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to incur any liability during the current tax year based on the reason(s) indicated above. |
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Employee Signature |
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Date |
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Employer Name
Business Address
City, State, ZIP
Employer’s Signature
Federal Employer Identification Number
Telephone Number
Employee’s Quarterly Compensation (not required for applicants checking Box c or d above)
$
4190010101 |
4190010101 |