Pennsylvania Residency Certification Form
This file provides essential information about the Pennsylvania Residency Certification Form. It outlines the necessary steps for local tax withholding compliance in Pennsylvania. Employees must complete this form to ensure accurate local earned income tax collection.
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How do I fill this out?
To fill out the Pennsylvania Residency Certification Form, gather your personal information, including your home address and employer details. Ensure that all required fields are accurately completed to avoid delays in processing. Sign and date the form before submission to finalize your application.

How to fill out the Pennsylvania Residency Certification Form?
1
Gather your personal and employer information.
2
Complete all required fields on the form carefully.
3
Leave the Employer's FEIN field blank.
4
Sign and date the certification section.
5
Submit the completed form via email, fax, or mail.
Who needs the Pennsylvania Residency Certification Form?
1
New employees in Pennsylvania need this form to comply with local tax regulations.
2
Current employees experiencing a name or address change must submit this form.
3
Employers need this form to ensure correct local earned income tax withholding.
4
Taxpayers seeking to clarify their local taxation responsibilities should use this form.
5
Residents and workers in Pennsylvania must complete this form to avoid penalties.
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What are the instructions for submitting this form?
To submit the Pennsylvania Residency Certification Form, you can choose from several options. Email your completed form securely using your Chevron account to payroll@chevron.com. Alternatively, fax it to 925-790-6309 or send it via mail to Payroll Operations, P.O. Box 6041, San Ramon, CA, 94583-0741. It is advisable to send the form as soon as possible to ensure timely processing.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, keep an eye on local tax submission deadlines that may affect your filing obligations. Specific due dates can vary by municipality. Always stay updated with any changes in tax laws that may impact your residency certification.

What is the purpose of this form?
The purpose of the Pennsylvania Residency Certification Form is to provide essential information for local tax authorities regarding the residency status of employees. It ensures that employers withhold the correct local earned income tax from wages. This form is a key tool in maintaining accurate tax records and compliance with Pennsylvania's tax regulations.

Tell me about this form and its components and fields line-by-line.

- 1. Employee Information: Contains personal details such as name and address.
- 2. Employer Information: Includes the employer's name and location where the employee works.
- 3. Certification: A section requiring the employee's signature and date.
What happens if I fail to submit this form?
Failing to submit the Pennsylvania Residency Certification Form can lead to incorrect tax withholdings and potential penalties. It is crucial for both employees and employers to complete this form in a timely manner to avoid tax complications.
- Incorrect Tax Withholding: You may have the wrong amount deducted from your paycheck.
- Penalties: Non-compliance may lead to fines or additional taxes owed.
- Delayed Processing: Submit your form promptly to avoid delays in tax processing.
How do I know when to use this form?

- 1. New Employment: Submit the form when starting a new job in Pennsylvania.
- 2. Address Change: Notify authorities of your change of residence.
- 3. Tax Compliance: Employers require this form for tax withholding accuracy.
Frequently Asked Questions
How do I download the Pennsylvania Residency Certification Form?
You can easily download the form in a PDF format after filling it out on PrintFriendly.
Can I edit the PDF after downloading?
Yes, PrintFriendly allows you to edit the PDF before downloading it.
What information do I need to fill out?
You will need personal details such as your name, address, and employer information.
Is it mandatory to use this form?
Yes, it is required for compliance with local tax laws in Pennsylvania.
How can I submit the completed form?
You can submit the form via encrypted email, fax, or by mail.
Where do I find my PSD code?
You can find your PSD code through the Pennsylvania Department of Community & Economic Development website.
What happens if I don't submit the form?
Failure to submit may result in incorrect tax withholding.
Can I sign the form digitally?
Yes, you can sign the PDF digitally on PrintFriendly.
Is there a specific deadline for this form?
It is best to submit the form as soon as possible after employment or address change.
What is the purpose of this form?
The form ensures correct local earned income tax withholding for employees.
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