Transcription of REV-419 APPLICATION CERTIFICATE 20
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REV-419 APPLICATION CERTIFICATE 20
Employee Signature Date Employer Name Federal Employer Identification Number Business Address Telephone Number City State Zip Code Employer s Signature Employee s Quarterly Compensation (not required for applicants checking Box b or c above) $ I claim exception from withholding because: a.
I claim exception from withholding because: 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 ... Employee's Nonwithholding Application Certificate (REV-419) Created Date:
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