×
tax forms found in
Tax Form Code
Tax Form Name

Pennsylvania Free Printable Employee's Nonwithholding Application Certificate (REV-419) for 2024 Pennsylvania Employee's Nonwithholding Application Certificate

It appears you don't have a PDF plugin for this browser. Please use the link below to download 2023-pennsylvania-form-rev-419.pdf, and you can print it directly from your computer.

Employee's Nonwithholding Application Certificate
Employee's Nonwithholding Application Certificate (REV-419)

4190020105 (EX) 09-20 (FI) REV-419 EMPLOYEE’S NONWITHHOLDING APPLICATION CERTIFICATE START ➜ 20 Please print or type. A fill-in form may be obtained from www.revenue.pa.gov. EMPLOYEE INFORMATION SECTION I Employee Name: first, middle initial, last Social Security Number Street Address City State Zip Code Telephone Number Tax Year (not necessary if checking Box b below) EXEMPTION INFORMATION SECTION II 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 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. 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. c. I certify I am a legal resident of the state of 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. CERTIFICATION SECTION III 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. Example 08/15/2004 Employee Signature Date PLEASE SIGN AFTER PRINTING. Employer Name Federal Employer Identification Number Business Address Telephone Number City State Employer’s Signature PLEASE SIGN AFTER PRINTING. Reset Entire Form 4190020105 Zip Code Employee’s Quarterly Compensation (not required for applicants checking Box b or c above) $ PRINT FORM 4190020105 Instructions for REV-419 Employee’s Nonwithholding Application Certificate REV-419 IN (EX) 09-20 WHAT’S NEW The form has been redesigned to meet the branding, formatting and instructions standards used for all department forms. The instructions and form have also been updated as a result of recent amendments to the federal Servicemembers Civil Relief Act. GENERAL INFORMATION PURPOSE OF FORM Complete Form REV-419 so that your employer can withhold the correct Pennsylvania personal income tax from your pay. Complete a new Form REV-419 every year or when your personal or financial situation changes. Photocopies of this form are acceptable. NOTE: Unless the state of residence changes, residents of the reciprocal states listed in the next paragraph do not need to refile this application every year. GENERAL INSTRUCTIONS WHO IS ELIGIBLE FOR NONWITHHOLDING? 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. WHEN TO CLAIM? File this certificate with your employer as soon as you determine you are entitled to claim nonwithholding. You must file a certificate each year you are eligible (see Note above for an exception). If you are employed by more than one employer you must file a separate REV-419 with each employer. RESPONSIBILITIES OF EMPLOYEES 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. Claimants who qualify for complete Tax Forgiveness under section 304 of the Tax Reform Code must file a PA-40, www.revenue.pa.gov Pennsylvania Personal Income Tax Return, and Schedule SP to claim Tax Forgiveness even if they are eligible for nonwithholding. Under the 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 d below 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. RESPONSIBILITIES OF EMPLOYER If you agree not to withhold PA tax because your employee is a resident of a reciprocal state, you must withhold the other state’s tax. Retain Form REV-419 with your records. You are required to submit a copy of this certificate and accompanying attachments to the PA DEPARTMENT OF REVENUE, BUREAU OF INDIVIDUAL TAXES, PO BOX 280507, HARRISBURG, PA 17128-0507, when: 1. You have reason to believe this certificate is incorrect; 2. The PA taxable gross compensation of any employee who claimed exemption from nonwithholding on the form under Section II, Line a, exceeds $1,625 for any quarter; 3. The employee claims an exemption from withholding on the basis of residence in a reciprocal state (Indiana, Maryland, New Jersey, Ohio, Virginia or West Virginia) and therefore, you agree to withhold income tax of the employee’s state of residence; or 4. The employee claims an exemption from withholding under the SCRA, as amended. DEPARTMENT’S RESPONSIBILITY Upon receipt of any exemption application, the department will make a determination and notify the employer if a change is required. If the department disapproves the application, the employer must immediately commence withholding at the regular rate. Once a certificate is revoked by the department, the employer must send any new application received from the employee to the department for approval before implementing the nonwithholding. REV-419 RETURN TO FORM 1
Extracted from PDF file 2023-pennsylvania-form-rev-419.pdf, last modified June 2010

More about the Pennsylvania Form REV-419 Individual Income Tax TY 2023

We last updated the Employee's Nonwithholding Application Certificate in January 2024, so this is the latest version of Form REV-419, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form REV-419 directly from TaxFormFinder. You can print other Pennsylvania tax forms here.

Other Pennsylvania Individual Income Tax Forms:

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
Form 40 Instruction Booklet Income Tax Return Instruction Booklet (PA-40)
Form PA-40 SP PA Schedule SP - Special Tax Forgiveness
Form PA-40 A PA Schedule A - Interest Income
Form PA-40 PA-V PA-40 Payment Voucher

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms


Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form REV-419 from the Department of Revenue in January 2024.

Show Sources >

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!

Historical Past-Year Versions of Pennsylvania Form REV-419

We have a total of thirteen past-year versions of Form REV-419 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2022 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2021 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2020 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2019 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2018 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2017 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

2016 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

forms/publications 2015 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

forms/publications 2014 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

forms/publications 2013 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

forms/publications 2012 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)

forms/publications 2011 Form REV-419

Employee's Nonwithholding Application Certificate (REV-419)


TaxFormFinder Disclaimer:

While we do our best to keep our list of Pennsylvania Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

** This Document Provided By TaxFormFinder.org **
Source: http://www.taxformfinder.org/index.php/pennsylvania/form-rev-419