Form REV-420 AS PDF Details

In the landscape of state taxation and employment, the REV-420 AS form stands as a critical document for individuals working in Pennsylvania but residing in states with reciprocal tax agreements. Specifically designed by the Commonwealth of Pennsylvania's Department of Revenue, Bureau of Business Trust Fund Taxes, this form facilitates employees in declaring their nonresidency in Pennsylvania, thereby exempting them from Pennsylvania Personal Income Tax withholding. Furthermore, it authorizes the withholding of income tax for the employee's resident state, ensuring compliance with interstate agreements. The form necessitates meticulous completion by both employee and employer, with sections allocated for personal information, declaration of residency in specific states (Indiana, Maryland, Ohio, New Jersey, Virginia, West Virginia), and authorization for appropriate state tax withholding. Essential for maintaining accurate and legal payroll procedures, the form also demands that employees update their information should their state of residence change. The process underscores the importance of clear communication between employees, employers, and tax authorities, aiming to streamline tax administration and uphold the principles of reciprocity among states.

QuestionAnswer
Form Name Form Rev 420 As
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names rev 420 authorization to withhold, rev 420 pa nj form, form rev 420, pa form rev 420

Form Preview Example

REV-420 AS (10-99)(I)

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF REVENUE

BUREAU OF BUSINESS TRUST FUND TAXES

DEPT. 280904

HARRISBURG, PA 17128-0904

EMPLOYEE'S STATEMENT

OF NONRESIDENCE IN

PENNSYLVANIA AND

AUTHORIZATION TO WITHHOLD

OTHER STATE’S INCOME TAX

PLEASE PRINT OR TYPE

Employer Instructions: You must keep a copy of this form on file for each employee who claims exemption from withholding of Pennsylvania Personal Income Tax on compensation received in Pennsylvania and who authorizes withholding of income tax for another state for remit- tance to that state. Send the bottom portion of this form to the PA Department of Revenue, Bureau of Business Trust Fund Taxes, Dept. 280904, Harrisburg, PA 17128-0904. Photocopies of this form are acceptable. Unless the state of residence changes, it is not necessary to refile this statement each year.

Employee Instructions: You must complete both portions of this form to claim an exemption from withholding of Pennsylvania Personal Income Tax and to authorize withholding of your state’s income tax. Only residents of the states listed on this form are eligible for exemption of withholding from Pennsylvania since they are the only states with which there is a reciprocal agreement. If you change your residence from the state specified on this form, you must notify your employer and complete a new form within 10 days of that change of residence.

CUT HERE

EMPLOYER COPY (EMPLOYEE COMPLETES INFORMATION BELOW AND SIGNS)

Employee name:

First, Middle Initial, Last

 

 

Social Security Number

 

 

 

 

 

 

 

 

Home Address

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

Zip Code

 

 

 

 

 

I hereby declare that, under penalties of perjury, I am a resident of the state checked below:

 

 

 

INDIANA

MARYLAND

OHIO

NEW JERSEY

 

VIRGINIA

WEST VIRGINIA

and that pursuant to the reciprocal agreement between those states, I claim an exemption from withholding of Pennsylvania 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

Employee’s SignatureDate

(EMPLOYER COMPLETES INFORMATION BELOW)

Employer Name:

Federal Employer Identification Number (EIN)

 

 

Business Address

Telephone Number

 

(

)

City

State

Zip Code

 

 

 

CUT HERE

COPY TO BE SENT TO THE COMMONWEALTH OF PENNSYLVANIA

(EMPLOYEE COMPLETES INFORMATION BELOW AND SIGNS)

Employee name:

First, Middle Initial, Last

 

 

Social Security Number

 

 

 

 

 

 

 

 

Home Address

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

Zip Code

 

 

 

 

 

I hereby declare that, under penalties of perjury, I am a resident of the state checked below:

 

 

 

INDIANA

MARYLAND

OHIO

NEW JERSEY

 

VIRGINIA

WEST VIRGINIA

and that pursuant to the reciprocal agreement between those states, I claim an exemption from withholding of Pennsylvania 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

Employee’s SignatureDate

(EMPLOYER COMPLETES INFORMATION BELOW)

Employer Name:

Federal Employer Identification Number (EIN)

 

 

Business Address

Telephone Number

 

(

)

City

State

Zip Code