Form 1 - Resident Of The City Of Pittsburgh Certificate - City Of Pittsburgh printable pdf download

Form 1 - Resident Of The City Of Pittsburgh Certificate - City Of Pittsburgh

Rev 8/2000 Form 1 – Resident

City of Pittsburgh

DEPARTMENT OF FINACE

City-County Building

Pennsylvania

Earned Income Tax Division

Pittsburgh, PA 15219

(412) 255-2544

RESIDENT OF THE CITY OF PITTSBURGH CERTIFICATE

CLAIM FOR EXEMPTION FROM ANY OTHER MUNICIPALITIES EARNED INCOME TAX

TO BE RETAINED BY THE EMPLOYER

To Employer: _________________________________________________________________________________________

Address: __________________________________________________________________________________________

__________________________________________________________________________________________

Employee:

__________________________________________________________________________________________

Address: ___________________________________________________________________________________________

____________________________________________________________________________________________

SSN #: ____________________________________________________________________________________________

I hereby inform you that I became a resident of THE CITY OF PITTSBURGH on_________/________/__________ and have a

liability to pay an Earned Income Tax to the City and/or School District of Pittsburgh.

IF YOU ARE WITHHOLDING FOR ANOTHER TOWNSHIP, BOROUGH OR MUNICIPALITY, PLEASE STOP AND DIRECT

THE WITHHOLDING TO THE CITY OF PITTSBURGH. If you are not registered and need a tax form call (412) 255-2543.

CITY OF PITTSBURGH TAX COLLECTOR

I certify that this employee is registered as a taxpayer in my jurisdiction, and is paying the Earned Income Tax to his or her place

of residence.

Tax Collector’ s Signature: ________________________________________________________ Date: _________________

Form 1 - Resident Of The City Of Pittsburgh Certificate - City Of Pittsburgh