Withholding Of City Employment Tax On Nonresidents

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U.S. Department of Justice Seal
U.S. Department of Justice

Antitrust Division

  DATE:
ORGANIZATION CODE: 1142043060
SOCIAL SECURITY NUMBER: __________________



TO:Justice Payroll Services Center

FROM:Antitrust Division

SUBJECT:WITHHOLDING OF CITY EMPLOYMENT TAX ON NONRESIDENTS



_______I hereby certify that I am a nonresident of the City of Philadelphia and a Nonresident of the State of Pennsylvania.

_______I do consent to withholding.
Amount Allocated........................$ ___________.

_______I do not consent to withholding.



_______________________________
(Signature)



RESIDENCE ADDRESS: ______________________________________

______________________________________

______________________________________

ZIP CODE: ___________
Updated June 25, 2015

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