Employee Authorization To Withhold Multnomah County Income Tax Form - Multnomah County - Oregon

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Employee Authorization to
Withhold Multnomah County Income Tax
EMPLOYEE INFORMATION
Employee number
Social Security Number
Name
FIRST
MIDDLE INITIAL
LAST
Residence address
City
State
Zip Code
County of residence
Mailing address (if different than street address)
City
State
Zip Code
County
TAX INFORMATION
1.
I authorize my employer to withhold County Income Tax from my wages.
2.
I authorize my employer to withhold County Income Taxes plus an additional
$
from my wages each period.
3.
Please stop additional requested withholding.
4.
I do not wish my employer to withhold the tax at this time.
I am a Multnomah County Resident and choose to make either installments or a lump
sum payment.
I am not a Multnomah County Resident.
Note: Only Multnomah County Residents Should Fill Out and Return to Payroll
PLEASE RETURN THIS FORM TO PAYROLL
SIGNATURE
DATE
Return to Payroll
24

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Parent category: Financial
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