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Withholding Certificate City 2017-2023
YOUR RESIDENCE IS NOT IN THE SAME STATE AS
YOUR REGULAR PLACE OF EMPLOYMENT
DO YOU CONSENT TO WITHHOLDING
YES
NO
10. I ESTIMATE THAT ______ % OF MY ANNUAL COMPENSATION IS FOR SERVICES PERFORMED OUTSIDE THE CITY OR COUNTY
11. TOTAL NUMBER OF EXEMPTIONS (IF APPLICABLE)
12. OTHER ALLOWANCES (IF APPLICABLE)
$ 0.00
13. I CERTIFY THE INFORMATION SUBMITTED ON THIS CERTIFICATE IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
SIGNATURE:
REVIEWED BY:
The social security number...
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