Extracted from PDF file 2023-pennsylvania-residency-certification-form.pdf, last modified May 2017Residency Certification Form for Local Earned Income Tax Withholding
CLGS-32-6 (05/17) RESIDENCY CERTIFICATION FORM Local Earned Income Tax Withholding TO E M P L O Y E R S / TA X PAY E R S : This form is to be used by employers and taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes to the local EIT collector. This form must be used by employers when a new employee is hired or when a current employee notifies employer of a name or address change. Use the Address Search Application at dced.pa.gov/Act32 to determine PSD codes, EIT rates, and tax collector contact information. EMPLOYEE INFORMATION – RESIDENCE LOCATION NAME (Last Name, First Name, Middle Initial) SOCIAL SECURITY NUMBER STREET ADDRESS (No PO Box, RD or RR) ADDRESS LINE 2 CITY STATE ZIP CODE DAYTIME PHONE NUMBER MUNICIPALITY (City, Borough or Township) COUNTY RESIDENT PSD CODE TOTAL RESIDENT EIT RATE EMPLOYER INFORMATION – EMPLOYMENT LOCATION EMPLOYER BUSINESS NAME (Use Federal ID Name) EMPLOYER FEIN STREET ADDRESS WHERE ABOVE EMPLOYEE REPORTS TO WORK (No PO Box, RD or RR) ADDRESS LINE 2 CITY STATE ZIP CODE PHONE NUMBER MUNICIPALITY (City, Borough or Township) COUNTY WORK LOCATION PSD CODE WORK LOCATION NON-RESIDENT EIT RATE CERTIFICATION Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying schedules and statements and to the best of my (our) belief, they are true, correct and complete. SIGNATURE OF EMPLOYEE PHONE NUMBER DATE (MM/DD/YYYY) EMAIL ADDRESS For information on obtaining the appropriate MUNICIPALITY (City, Borough, Township), PSD CODES, and EIT (Earned Income Tax) RATES, please refer to the Pennsylvania Department of Community & Economic Development website: dced.pa.gov/Act32
gclgs-32-6_2017_Comm Empower
This form is to be used by employers and taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes to the local EIT collector. This form must be used by employers when a new employee is hired or when a current employee notifies employer of a name or address change.
We last updated the Residency Certification Form for Local Earned Income Tax Withholding in January 2024, so this is the latest version of Residency Certification Form , fully updated for tax year 2023. You can download or print current or past-year PDFs of Residency Certification Form directly from TaxFormFinder. You can print other Pennsylvania tax forms here.
TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form PA-40 | Pennsylvania Income Tax Return Tax Return |
| Form 40 Instruction Booklet | Income Tax Return Instruction Booklet (PA-40) |
| Form PA-40 SP | PA Schedule SP - Special Tax Forgiveness Tax Credit |
| Form PA-40 A | PA Schedule A - Interest Income |
| Form PA-40 PA-V | PA-40 Payment Voucher Voucher |
View all 175 Pennsylvania Income Tax Forms
Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Residency Certification Form from the Department of Revenue in January 2024.
About the Individual Income Tax
The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.
Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!
We have a total of five past-year versions of Residency Certification Form in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
