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Get Pa Dced Clgs-32-6 2011

CLGS-32-6 8-11 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/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes. EMPLOYEE INFORMATION - RESIDENCE LOCATION NAME Last Name First Name Middle Initial SOCIAL SECURITY NUMBER STREET ADDRESS No PO Box RD or RR SECOND LINE OF ADDRESS CITY STATE ZIP CODE DAYTIME PHONE NUMBER MUNICIPALITY City Borough .

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