Substitute State Tax Withholding Certificate Form: Iowa Page 2

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Pension Fund of the Christian Church
Substitute State Tax Withholding Certificate: Iowa
IV: CERTIFICATION
I certify that I have completed this Certificate and, to the best of my knowledge and belief, it is true,
complete and correct.
Signature
Date ______/_______/_______
Printed Name
Pin # _____________________
1
In making this election, you are certifying that you are not subject to state withholding, either because you have
elected “no withholding” for federal purposes, or because you otherwise meet your state’s conditions for exemption.
2
For periodic payments, you cannot enter an additional withholding amount without entering the number
of allowances/exemptions.
V1 11-2015

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