Form REV-419 at a glance
What it is: Complete Form REV-419 so that your employer can withhold the correct Pennsylvania personal income tax from your pay.[1]
A filled-in Form REV-419 example: a Virginia resident who works in Pennsylvania claims Box b
How to fill out Form REV-419, box by box
Tap a group of boxes to open it, and a picture to see it full size.
Employee information (Section I)
Under Section I, Employee Information, fill in Employee Name (first, middle initial, last), Social Security Number and Telephone Number.
Fill in Street Address, City, State, Zip Code and Tax Year (not necessary if checking Box b).[1]
Why you claim the exception (Section II)
Section II, Exemption Information: I claim exception from withholding because:
Box 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.
Box 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. Box c: I certify I am a legal resident of the state of (the blank) 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.
Under the Servicemembers Civil Relief Act (SCRA), as amended, you may be exempt from PA personal income tax on your wages if (i) your spouse is a member of the armed forces present in PA in compliance with military orders; (ii) you are present in PA solely to be with your spouse; and (iii) you and your spouse both maintain domicile (state residency) in another state.
If you claim exemption under the SCRA, enter your state of domicile (legal residence) on Line c and attach a copy of your spousal military identification card and your spouse's current military orders to form REV-419.
See Personal Income Tax Bulletin 2010-01 for additional information.
Common mistake: Claimants who qualify for complete Tax Forgiveness under section 304 of the Tax Reform Code must file a PA-40, Pennsylvania Personal Income Tax Return, and Schedule SP to claim Tax Forgiveness even if they are eligible for nonwithholding.[1]
Certification and the employee's signature (Section III)
Section III, Certification: 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 and Date: PLEASE SIGN AFTER PRINTING; the form prints Example 08/15/2004 for the date.[1]
The employer's lines
Employer Name, Federal Employer Identification Number, Business Address, Telephone Number, City, State and Zip Code.
Employer's Signature: PLEASE SIGN AFTER PRINTING. Employee's Quarterly Compensation (not required for applicants checking Box b or c in Section II).[1]
More rules for Form REV-419
Please print or type. A fill-in form may be obtained from www.revenue.pa.gov.[1]
Photocopies of this form are acceptable.[1]
File with your employer
File it with each employer, or revoke it
File this certificate with your employer as soon as you determine you are entitled to claim nonwithholding.
Common mistake: If you are employed by more than one employer you must file a separate REV-419 with each employer.
Common mistake: You must revoke this certification within 10 days from the day you anticipate you will incur PA personal income tax liability for the current tax year.
To discontinue or revoke this certification, submit notification in writing to your employer.[1]
Common questions about Form REV-419
Who is exempt from PA tax withholding?
You may be entitled to nonwithholding of PA personal income tax if you incurred no liability for 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, 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 or as the spouse of an active duty service member under the Servicemembers Civil Relief Act (SCRA), as amended.[1]
How long is a pa exemption certificate good for?
Complete a new Form REV-419 every year or when your personal or financial situation changes. You must file a certificate each year you are eligible (see the NOTE for an exception). NOTE: Unless the state of residence changes, residents of the reciprocal states (the states listed in Box b) do not need to refile this application every year.[1]
Does it need a notary?
No notary is named anywhere on Form REV-419.
Are there fees?
The form does not say.
Is there a penalty for filing late?
The form does not say.
When is this form not the right one?
The form does not say.
Sources
[1] Form REV-419 (EX) 09-20, Employee's Nonwithholding Application Certificate, with its instructions REV-419 IN (EX) 03-24, Pennsylvania Department of Revenue (the Official source link on this page).