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.
| Question | Answer |
|---|---|
| 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 |
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF BUSINESS TRUST FUND TAXES
DEPT. 280904
HARRISBURG, PA
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
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 |
|
|
|