Form CLGS-32-6 "Residency Certification'(form" - Pennsylvania

What Is Form CLGS-32-6?

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

Form Details:

  • Released on June 1, 2013;
  • The latest edition provided by the Pennsylvania Department of Community and Economic Development;
  • 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 fillable version of Form CLGS-32-6 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Community and Economic Development.

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Download Form CLGS-32-6 "Residency Certification'(form" - Pennsylvania

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CLGS-32-6 (05/17)
RESIDENCY CERTIFICATION FORM
Local Earned Income Tax Withholding
TO   E M P L O Y E R S / TA X PAY E R S :
This form is to be used by employers and taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes
to the local EIT collector. This form must be used by employers when a new employee is hired or when a current employee notifies employer
of a name or address change. Use the Address Search Application at dced.pa.gov/Act32 to determine PSD codes, EIT rates,
and tax collector contact information.
EMPLOYEE INFORMATION – RESIDENCE LOCATION
NAME (Last Name, First Name, Middle Initial)
SOCIAL SECURITY NUMBER
STREET ADDRESS (No PO Box, RD or RR)
ADDRESS LINE 2
CITY
STATE
ZIP CODE
DAYTIME PHONE NUMBER
MUNICIPALITY (City, Borough or Township)
COUNTY
RESIDENT PSD CODE
TOTAL RESIDENT EIT RATE
EMPLOYER INFORMATION – EMPLOYMENT LOCATION
EMPLOYER BUSINESS NAME (Use Federal ID Name)
EMPLOYER FEIN
STREET ADDRESS WHERE ABOVE EMPLOYEE REPORTS TO WORK (No PO Box, RD or RR)
ADDRESS LINE 2
CITY
STATE
ZIP CODE
PHONE NUMBER
MUNICIPALITY (City, Borough or Township)
COUNTY
WORK LOCATION PSD CODE
WORK LOCATION NON-RESIDENT EIT RATE
CERTIFICATION
Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying
schedules and statements and to the best of my (our) belief, they are true, correct and complete.
SIGNATURE OF EMPLOYEE
DATE (MM/DD/YYYY)
PHONE NUMBER
EMAIL ADDRESS
For information on obtaining the appropriate MUNICIPALITY (City, Borough, Township), PSD CODES, and EIT (Earned Income Tax) RATES,
please refer to the Pennsylvania Department of Community & Economic Development website:
dced.pa.gov/Act32
CLGS-32-6 (05/17)
RESIDENCY CERTIFICATION FORM
Local Earned Income Tax Withholding
TO   E M P L O Y E R S / TA X PAY E R S :
This form is to be used by employers and taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes
to the local EIT collector. This form must be used by employers when a new employee is hired or when a current employee notifies employer
of a name or address change. Use the Address Search Application at dced.pa.gov/Act32 to determine PSD codes, EIT rates,
and tax collector contact information.
EMPLOYEE INFORMATION – RESIDENCE LOCATION
NAME (Last Name, First Name, Middle Initial)
SOCIAL SECURITY NUMBER
STREET ADDRESS (No PO Box, RD or RR)
ADDRESS LINE 2
CITY
STATE
ZIP CODE
DAYTIME PHONE NUMBER
MUNICIPALITY (City, Borough or Township)
COUNTY
RESIDENT PSD CODE
TOTAL RESIDENT EIT RATE
EMPLOYER INFORMATION – EMPLOYMENT LOCATION
EMPLOYER BUSINESS NAME (Use Federal ID Name)
EMPLOYER FEIN
STREET ADDRESS WHERE ABOVE EMPLOYEE REPORTS TO WORK (No PO Box, RD or RR)
ADDRESS LINE 2
CITY
STATE
ZIP CODE
PHONE NUMBER
MUNICIPALITY (City, Borough or Township)
COUNTY
WORK LOCATION PSD CODE
WORK LOCATION NON-RESIDENT EIT RATE
CERTIFICATION
Under penalties of perjury, I (we) declare that I (we) have examined this information, including all accompanying
schedules and statements and to the best of my (our) belief, they are true, correct and complete.
SIGNATURE OF EMPLOYEE
DATE (MM/DD/YYYY)
PHONE NUMBER
EMAIL ADDRESS
For information on obtaining the appropriate MUNICIPALITY (City, Borough, Township), PSD CODES, and EIT (Earned Income Tax) RATES,
please refer to the Pennsylvania Department of Community & Economic Development website:
dced.pa.gov/Act32