Form IT4NR "Employee's Statement of Residency in a Reciprocity State" - Ohio

Form IT4NR is a Ohio Department of Taxation form also known as the "Employee's Statement Of Residency In A Reciprocity State". The latest edition of the form was released in May 1, 2007 and is available for digital filing.

Download an up-to-date Form IT4NR in PDF-format down below or look it up on the Ohio Department of Taxation Forms website.

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Download Form IT4NR "Employee's Statement of Residency in a Reciprocity State" - Ohio

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Ohio Form IT 4NR
Statement of Residency
please detach here
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IT 4NR
Employee’s Statement of Residency
Rev. 5/07
in a Reciprocity State
Print full name
Social Security number
Home address and ZIP code
Ohio employers: You are required to have a copy of this form on file for each employee who is a resident of Indiana, Kentucky, West Virginia, Michigan
or Pennsylvania receiving compensation paid in Ohio and who claims exemption from withholding of Ohio income tax under the reciprocal agreements
between Ohio and these other states.
Employees residing outside Ohio and in a state with whom Ohio has reciprocity: If you are a resident of a state with whom Ohio has reciprocity, you
may claim exemption from withholding of Ohio income tax by completing this form and filing it with your employer under the reciprocal withholding agree-
ments between Ohio and these states.
Note: If you change your residence from the state specified herein to any other state, you must notify your employer within 10 days.
I hereby declare, under penalties of perjury, that I am a resident of the state of
and that, pursuant to an agreement existing
between that state and the state of Ohio, I claim exemption from withholding of Ohio income tax on compensation paid to me in the state of Ohio.
Signature
Date
Ohio Form IT 4NR
Statement of Residency
please detach here
Reset Form
IT 4NR
Employee’s Statement of Residency
Rev. 5/07
in a Reciprocity State
Print full name
Social Security number
Home address and ZIP code
Ohio employers: You are required to have a copy of this form on file for each employee who is a resident of Indiana, Kentucky, West Virginia, Michigan
or Pennsylvania receiving compensation paid in Ohio and who claims exemption from withholding of Ohio income tax under the reciprocal agreements
between Ohio and these other states.
Employees residing outside Ohio and in a state with whom Ohio has reciprocity: If you are a resident of a state with whom Ohio has reciprocity, you
may claim exemption from withholding of Ohio income tax by completing this form and filing it with your employer under the reciprocal withholding agree-
ments between Ohio and these states.
Note: If you change your residence from the state specified herein to any other state, you must notify your employer within 10 days.
I hereby declare, under penalties of perjury, that I am a resident of the state of
and that, pursuant to an agreement existing
between that state and the state of Ohio, I claim exemption from withholding of Ohio income tax on compensation paid to me in the state of Ohio.
Signature
Date
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