Form Rev 419 PDF Details

In order to ensure that you are completing your Form 419 correctly, it is important to be familiar with the information that is required. This form must be completed accurately in order to timely process your claim. Here, we will provide an overview of what is required on the Form 419 so that you can submit a complete and accurate submission. By understanding what is needed on this form, you can avoid any delays in processing your claim.

QuestionAnswer
Form NameForm Rev 419
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespa rev 419, form rev 419, rev 419 ex form 2018, pennsylvania rev 419

Form Preview Example

4190010101

REV-419 EX (05-10)

Employee’s Nonwithholding

Application Certificate

PA DEPARTMENT OF REVENUE

20

OFFICIALUSE ONLY

Purpose. Complete Form REV-419 so that your employer can withhold the correct Pennsylvania personal income tax from your pay. Complete a new Form REV-419 every year or when your personal or financial situa- tion changes. Photocopies of this form are acceptable.

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 REV-419 with each employer.

Responsibilities of Employee. You must

and accompanying attachments to the PA

revoke this certification within 10 days from

DEPARTMENTOFREVENUE,BUREAUOFBUSI-

the day you anticipate you will incur PA per-

NESS TRUST FUND TAXES, PO BOX 280904,

sonal income tax liability for the current tax

HARRISBURG, PA 17128-0904, when:

year.Todiscontinueorrevokethiscertification,

1.

you have reason to believe this certificate

submitnotificationinwritingtoyouremployer.

 

is incorrect;

Claimants who qualify for complete Tax

 

2.

thePAtaxablegrosscompensationofany

Forgiveness under section 304 of the Tax

 

employee who claimed either exemption

Reform Code must file a PA-40, Pennsylvania

 

 

fromnonwithholdingaorbbelowexceeds

Personal Income Tax Return, and Schedule SP

 

 

$1,625 for any quarter;

toclaimTaxForgivenesseveniftheyareeligi-

 

3.

the employee claims an exemption from

ble for nonwithholding.

 

withholding on the basis of residence in a

Under the SCRA, as amended by the Military

 

 

reciprocal state (Indiana, Maryland, New

Spouses Residency Relief Act, you may be

 

Jersey, Ohio, Virginia or West Virginia)

exempt from PA personal income tax on your

 

and therefore, you agree to withhold

wages if (i) your spouse is a member of the

 

incometaxoftheemployee’sstateofres-

armed forces present in PA in compliance with

 

idence; or

militaryorders;(ii)youarepresentinPAsolely

4.

the employee claims an exemption from

to be with your spouse; and (iii) you and your

 

withholding under the SCRA as amended

spouse both maintain the same domicile

 

 

by the Military Spouses Residency Relief

(stateresidency)inanotherstate.Ifyouclaim

 

 

Act.

exemption under the SCRA, enter your state

 

 

 

of domicile (legal residence) on Line d below

Department’s Responsibility. Upon receipt

and attach a copy of your spousal military

of any exemption application, the department

identification card and your spouse’s current

will make a determination and notify the

military orders to form REV-419.

employer if a change is required. If the

ResponsibilitiesofEmployer.

department disapproves the application, the

employer must immediately commence with-

If you agree not to withhold PA tax because

holding at the regular rate. Once a certificate

your employee is a resident of a reciprocal

is revoked by the department, the employer

state,youmustwithholdtheotherstate’stax.

must send any new application received from

RetainFormREV-419withyourrecords.Youare

the employee to the department for approval

required to submit a copy of this certificate

before implementing the nonwithholding.

Please print or type. A fill-in form may be obtained from www.revenue.state.pa.us.

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

and that pursuant tothe reciprocaltax agreementbetween that stateandPA, I claiman exemption from withholdingof 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.

d. 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 by the Military Spouses Residency Relief Act.

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

to incur any liability during the current tax year based on the reason(s) indicated above.

 

 

 

 

 

 

 

 

 

 

Employee Signature

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

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