Form Pwh-Ww - Performer Or Performing Entity Request For Waiver Of Withholding printable pdf download

Form PWH-WW

Massachusetts

Performer or Performing Entity

Department of

Request for Waiver of Withholding

Revenue

Name of performer and/or performing entity

Social Security and/or Federal Identification number

Address

City/Town

State

Zip

Name of performer withholding agent

Massachusetts Tax Registration number

Address

City/Town

State

Zip

Name of venue

Date(s) of performance

A performer or performing entity should use this form to request a waiver of Massachusetts income tax withholding from a performer withholding agent. The

completed form should be mailed to Massachusetts DOR, Bureau of Desk Audit, Filing Enforcement — Entertainment, 200 Arlington Street, Fourth

Floor, Chelsea, MA, 02150 or faxed to 617 887-6589. Massachusetts DOR must receive this form at least ten business days before the performance in

order to authorize a waiver of withholding. If the request is granted, DOR will send a Notice of Withholding Waiver to the performer withholding agent and

a copy to the performer or performing entity. For more information, see A Guide to Withholding Taxes on Performers and Performing Entities , available at

or by calling 617-887-MDOR.

Declaration by Resident Performer

I am a resident of Massachusetts and reside at the address shown above. I have filed all required Massachusetts tax returns, past and present, and have

paid all required Massachusetts taxes, including any required estimated Massachusetts income tax for the current taxable year. Should I cease to be a Mass-

achusetts resident, I will promptly inform you. I understand that, even if Massachusetts income tax is not withheld from the payment made to me for my

performance in Massachusetts at the above-named venue on the above-specified date(s) of performance, the payment remains subject to Massachusetts

income tax. I declare under penalty of perjury that the information contained on this form is, to the best of my knowledge and belief, true, complete, and

correct. I understand that the penalty for willfully making a false statement to DOR is a fine of not more than $1,000, or imprisonment for not more than two

and one-half years, or both.

Signature

Date

Declaration by Performer Who Is an Employee of Performer Withholding Agent

I am treated, for federal income tax withholding purposes, as an employee of the performer withholding agent. Should I cease to be treated, for federal

income tax withholding purposes, as an employee of the performer withholding agent, I will promptly inform you. I declare under penalty of perjury that the

information contained on this form is, to the best of my knowledge and belief, true, complete, and correct. I understand that the penalty for willfully making

a false statement to DOR is a fine of not more than $1,000, or imprisonment for not more than two and one-half years, or both.

Signature

Date

Declaration by Performing Entity Continuously Maintaining an Office in Massachusetts

The performing entity named above has an office in Massachusetts at the address shown above, and the office is continuously maintained, occupied, and

used by the performing entity’s regular employees who are regularly in attendance to carry on its business in its own name. The performing entity has filed

all required Massachusetts tax returns, past and present, and has paid all required Massachusetts taxes. Should the performing entity cease to have an

office in Massachusetts, I will promptly inform you. I understand that, even if Massachusetts income tax is not withheld from the payment made for the per-

forming entity’s performance in Massachusetts at the above-named venue on the above-specified date(s) of performance, the payment remains subject to

Massachusetts income tax. I declare under penalty of perjury that the information contained on this form is, to the best of my knowledge and belief, true,

complete, and correct. I understand that the penalty for willfully making a false statement to DOR is a fine of not more than $1,000, or imprisonment for not

more than two and one-half years, or both.

Name and title

Signature

Date

Declaration by Performing Entity Registered as an Employer with DOR

The performing entity named above is registered with DOR to withhold Massachusetts income tax as an employer and will withhold and pay over

Massachusetts income tax on behalf of members or participants in the performing entity for services performed at the above-named venue on the above-

specified date(s) of performance. The performing entity has filed all required Massachusetts tax returns, past and present, and has paid all required

Massachusetts taxes. Should the performing entity cease to be registered with DOR to withhold Massachusetts income tax as an employer, I will promptly

inform you. I declare under penalty of perjury that the information contained on this form is, to the best of my knowledge and belief, true, complete, and cor-

rect. I understand that the penalty for willfully making a false statement to DOR is a fine of not more than $1,000, or imprisonment for not more than two

and one-half years, or both.

Name and title

Signature

Date

Form Pwh-Ww - Performer Or Performing Entity Request For Waiver Of Withholding

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