Form I862 - Affidavit For Low Income Employees -Emergency Municipal Services Tax (Emst)
ADVERTISEMENT
1I862
7/05
Emergency Municipal Services Tax (EMST)
Affidavit for Low Income Employees
INSTRUCTIONS: To be used ONLY for Employees who are expected to earn less than the stated EMST exemption
amount for your area. Copies of this form are acceptable if additional space or forms are needed.
You may still be subject to the tax amount due the school district, if one is in place, dependent on what the district’s
exemption amount is. Therefore you may only be eligible for exemption from the municipal portion of the tax. Your
employer should be withholding the school district portion of the tax (maximum of $10.00) if this is truly due. If
they fail to do so, you will be billed directly for the amount due.
Employer Name & Account Number: _________________________________-_____________
Employee Name: _____________________________________________________________
Employee Address: ___________________________________________________________
Social Security Number: _______________________________________________________
I862
7/05
Emergency Municipal Services Tax (EMST)
Affidavit for Low Income Employees
INSTRUCTIONS: To be used ONLY for Employees who are expected to earn less than the stated EMST exemption
amount for your area. Copies of this form are acceptable if additional space or forms are needed.
You may still be subject to the tax amount due the school district, if one is in place, dependent on what the district’s
exemption amount is. Therefore you may only be eligible for exemption from the municipal portion of the tax. Your
employer should be withholding the school district portion of the tax (maximum of $10.00) if this is truly due. If
they fail to do so, you will be billed directly for the amount due.
Employer Name & Account Number: _________________________________-_____________
Employee Name: _____________________________________________________________
Employee Address: ___________________________________________________________
Social Security Number: _______________________________________________________
I862
7/05
Emergency Municipal Services Tax (EMST)
Affidavit for Low Income Employees
INSTRUCTIONS: To be used ONLY for Employees who are expected to earn less than the stated EMST exemption
amount for your area. Copies of this form are acceptable if additional space or forms are needed.
You may still be subject to the tax amount due the school district, if one is in place, dependent on what the district’s
exemption amount is. Therefore you may only be eligible for exemption from the municipal portion of the tax. Your
employer should be withholding the school district portion of the tax (maximum of $10.00) if this is truly due. If
they fail to do so, you will be billed directly for the amount due.
Employer Name & Account Number: _________________________________-_____________
Employee Name: _____________________________________________________________
Employee Address: ___________________________________________________________
Social Security Number: _______________________________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial