NATIVE AMERICAN STATE INCOME TAX WITHHOLDING EXEMPTION CERTIFICATE
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 5517, Withholding State income taxes.
PRINCIPAL PURPOSE(S): To enable a Native American service member to stop State income tax withholding from military compensation.
ROUTINE USE(S): The information obtained will become part of the military pay system of the service concerned and may be disclosed as
stated in the applicable system of records notices, T7344, Defense Joint Military Pay System – Reserve Component; T7340, Defense Joint
Military Pay System – Active Component; and M01040-3, Marine Corps Manpower Management Information System Records, located at
http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary; however, failure to complete this form will result in withholding of State income taxes from your pay.
DoD ID NUMBER
1. NAME (Last, First, Middle Initial)
2.
3. MILITARY ADDRESS (Unit, Street, City, State, ZIP Code)
4. CURRENT MAILING ADDRESS (Street, City, State, ZIP Code)
5. NAME OF FEDERALLY RECOGNIZED TRIBE THAT YOU ARE A MEMBER OF
6. NAME OF FEDERALLY RECOGNIZED TRIBAL RESERVATION OR INDIAN COUNTRY THAT YOU CLAIM AS YOUR DOMICILE (Include the
name of the State the reservation is located within)
7. I CERTIFY THAT I ANTICIPATE MEETING THE TWO CONDITIONS NECESSARY TO BE EXEMPT FROM WITHHOLDING
FOR THE CALENDAR YEAR
. I ALSO DECLARE THAT I WILL IMMEDIATELY NOTIFY THE FINANCE OFFICER
OF ANY CHANGES THAT AFFECT MY WITHHOLDING STATUS.
8. SIGNATURE OF APPLICANT
9. DATE (YYYYMMDD)
INSTRUCTIONS
Completing this certificate allows you to claim exemption from State income tax withholding on your military
compensation if you satisfy the following tests:
1. You claim as your State of legal residency/domicile a federally recognized tribal reservation or Indian Country.
2. You are an enrolled member of that federally recognized Native American tribe.
If you satisfy these conditions, the Soldiers' and Sailors' Civil Relief Act provides that your tax home remains on the
reservation/in Indian country. Consequently, you may stop State income tax withholding on your military compensation.
If you have any doubt with regard to your State of legal residence/domicile, you are advised to see your Legal
Assistance Officer (JAG representative) for advice prior to completing this form.
Effective date of exemption election. Withholding of State income tax will stop the month after the month in which you
file this certificate. DFAS cannot make retroactive adjustments.
DD FORM 2058-2, JAN 2018
Reset
NATIVE AMERICAN STATE INCOME TAX WITHHOLDING EXEMPTION CERTIFICATE
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 5517, Withholding State income taxes.
PRINCIPAL PURPOSE(S): To enable a Native American service member to stop State income tax withholding from military compensation.
ROUTINE USE(S): The information obtained will become part of the military pay system of the service concerned and may be disclosed as
stated in the applicable system of records notices, T7344, Defense Joint Military Pay System – Reserve Component; T7340, Defense Joint
Military Pay System – Active Component; and M01040-3, Marine Corps Manpower Management Information System Records, located at
http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary; however, failure to complete this form will result in withholding of State income taxes from your pay.
DoD ID NUMBER
1. NAME (Last, First, Middle Initial)
2.
3. MILITARY ADDRESS (Unit, Street, City, State, ZIP Code)
4. CURRENT MAILING ADDRESS (Street, City, State, ZIP Code)
5. NAME OF FEDERALLY RECOGNIZED TRIBE THAT YOU ARE A MEMBER OF
6. NAME OF FEDERALLY RECOGNIZED TRIBAL RESERVATION OR INDIAN COUNTRY THAT YOU CLAIM AS YOUR DOMICILE (Include the
name of the State the reservation is located within)
7. I CERTIFY THAT I ANTICIPATE MEETING THE TWO CONDITIONS NECESSARY TO BE EXEMPT FROM WITHHOLDING
FOR THE CALENDAR YEAR
. I ALSO DECLARE THAT I WILL IMMEDIATELY NOTIFY THE FINANCE OFFICER
OF ANY CHANGES THAT AFFECT MY WITHHOLDING STATUS.
8. SIGNATURE OF APPLICANT
9. DATE (YYYYMMDD)
INSTRUCTIONS
Completing this certificate allows you to claim exemption from State income tax withholding on your military
compensation if you satisfy the following tests:
1. You claim as your State of legal residency/domicile a federally recognized tribal reservation or Indian Country.
2. You are an enrolled member of that federally recognized Native American tribe.
If you satisfy these conditions, the Soldiers' and Sailors' Civil Relief Act provides that your tax home remains on the
reservation/in Indian country. Consequently, you may stop State income tax withholding on your military compensation.
If you have any doubt with regard to your State of legal residence/domicile, you are advised to see your Legal
Assistance Officer (JAG representative) for advice prior to completing this form.
Effective date of exemption election. Withholding of State income tax will stop the month after the month in which you
file this certificate. DFAS cannot make retroactive adjustments.
DD FORM 2058-2, JAN 2018
Reset
Download DD Form 2058-2 Native American State Income Tax Withholding Exemption Certificate
DD Form 2058-2 Instructions
- First of all, make sure your place of legal residence is a federally recognized Indian reservation. Also, make sure that you are an enrolled member of that federally recognized Native American tribe.
- If your status is unclear or you have questions about filling, contact your Legal Assistance Officer (JAG representative) for advice prior to completing this form.
- File the form only if you satisfy the conditions above. Write down your name, identification, military address and current mailing address. State the name of the federally recognized tribe that you are a member of and name of the tribal reservation or Indian country that you claim as your domicile. List the of the state the reservation is located within. Sign and date the form before handing it to your military personnel office.
The Defence Finance and Accounting Service cannot make retroactive adjustments: income tax withholding will stop in a month after the month when you file the DD Form 2058-2.
Forms Related to DD Form 2058-2
- DD Form 2058 or the State of Legal Residence Certificate is used to indicate a change in your State of Legal Residence (SLR) for military pay purposes.
- DD Form 2058-1, State Income Tax Exemption Test Certificate is used by soldiers with residence in states that exclude some portion of military pay from income tax.
