Pbgc Form 719 - Election To Withhold Federal Income Tax From Periodic Payments Page 3
ADVERTISEMENT
1
2
3Election to Withhold Federal Income Tax from Periodic Payments
Form 719, page 2 of 2
Plan Number:
FX.PrismCase.CaseIdNmbr.XF
Participant Name:
FX.PrismCust.FullName.XF
What happens if you do not choose any option?
If you do not choose one of these options, we will withhold federal taxes as if you were a married individual with
three allowances. The amount we will withhold depends on your monthly pension.
What if you want to pick a different option later?
You may change your option at any time. To choose a different option, simply call PBGC's Customer Contact
Center at 1-800-400-7242. We will then send you a tax withholding form to complete. Depending on when we
receive it, we will make the change by the next month or the month after that.
What if you don't live in the United States?
If you live outside the United States, you cannot elect option A. You may be eligible for special tax treatment
under a tax treaty with the country you reside in. We will send you additional information after you file this form.
When determining your federal tax withholding, you may find it helpful to read the IRS instructions for completing
the IRS Form W-4P (Withholding Certificate for Pension or Annuity Payments). You can print a copy from the
IRS Internet site under Forms and Publications at
Election
- In general, tax laws require PBGC to withhold federal income tax from your pension payments, unless you
specifically elect not to have taxes withheld. Select only one option - A or B or C.
A.
I elect not to have federal income tax withheld. (Available to U.S. residents only.)
OR
B.
I elect to have federal income tax withheld based on IRS instructions.
Single
Married
Marital Status
(REQUIRED)
Number of withholding allowances
(REQUIRED)
.00
Additional monthly amount to be withheld (optional)
$
:
OR
C.
I elect to have the following amount withheld for federal income tax.
The dollar amount or percentage to be withheld monthly
.00
%
OR ______
$
is:
If you do not choose an option, we will withhold federal income taxes as if you were a married individual with three
allowances. This means that for year 2016, we will withhold taxes only if your monthly PBGC benefit is $1,720 or
more.
3. Signature
– Sign and date this form.
SIGNATURE
DATE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial