Form SF9686 (WH-47) "Certificate of Residence" - Indiana

What Is Form SF9686 (WH-47)?

This is a legal form that was released by the Indiana Department of Revenue - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 1997;
  • The latest edition provided by the Indiana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form SF9686 (WH-47) by clicking the link below or browse more documents and templates provided by the Indiana Department of Revenue.

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Download Form SF9686 (WH-47) "Certificate of Residence" - Indiana

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Certificate of Residence
WH-47
Form
SF# 9686 (R/12-97)
This form is to be used only by residents of States with a reciprocal tax agreement.*
Indiana Employer's Name
Employer TID Number
Employee Name
Street and City Address
Social Security Number
The employee swears to be a legal resident of the State of
, does not own personal
property in Indiana, and understands that income from salaries, wages, tips and commissions received from Indiana sources
are taxable in their state of residence and not subject to Indiana Adjusted Gross Income Tax as a result of the reciprocal tax
agreement with the State of
. Employee further states the Indiana employer will be advised
of any change in legal residence. Note: The employee understands that the employer remains responsible for withholding
any applicable Indiana County taxes.
Date
,
Employee Signature
Subscribed and sworn to before me, a Notary Public in and for said County and State, this
day of
,
.
Notary Public Signature
My Commission Expires
My County of Residence
Do not send this form to the Indiana Department of Revenue
it is to be filed with and held by the employer.
*States that have reciprocal agreements with Indiana are: Kentucky, Michigan, Ohio, Pennsylvania and Wisconsin.
Certificate of Residence
WH-47
Form
SF# 9686 (R/12-97)
This form is to be used only by residents of States with a reciprocal tax agreement.*
Indiana Employer's Name
Employer TID Number
Employee Name
Street and City Address
Social Security Number
The employee swears to be a legal resident of the State of
, does not own personal
property in Indiana, and understands that income from salaries, wages, tips and commissions received from Indiana sources
are taxable in their state of residence and not subject to Indiana Adjusted Gross Income Tax as a result of the reciprocal tax
agreement with the State of
. Employee further states the Indiana employer will be advised
of any change in legal residence. Note: The employee understands that the employer remains responsible for withholding
any applicable Indiana County taxes.
Date
,
Employee Signature
Subscribed and sworn to before me, a Notary Public in and for said County and State, this
day of
,
.
Notary Public Signature
My Commission Expires
My County of Residence
Do not send this form to the Indiana Department of Revenue
it is to be filed with and held by the employer.
*States that have reciprocal agreements with Indiana are: Kentucky, Michigan, Ohio, Pennsylvania and Wisconsin.