EMPLOYEE CERTIFICATION OF RESIDENCY OR NON RESIDENCY
WARREN COUNTY SCHOOLS OCCUPATIONAL TAX OFFICE
P.O. Box 51530, 303 Lovers Lane, Bowling Green, KY 42103
♦
The information on this form will determine if Warren County Schools Occupational Tax is to be
withheld from your wages.
♦
If you are unsure of the school district you reside in, please call our office for verification at
(270) 842-7168.
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If you change your place of residence during the year, it is very important that you to notify your
payroll department.
FULL NAME: _______________________________________________________________
SOCIAL SECURITY NUMBER: ________________________________________________
HOME ADDRESS: ___________________________________________________________
(or temporary address)
_________________________________________________
______
I DO
live in the Warren County School District.
______
I DO NOT
live in the Warren County School District.
SIGNATURE: _______________________________________________ DATE: ______________________
This form is to be filled out by you and retained by your employer. It becomes your employer’s
authorization to withhold the Warren County Schools Occupational Tax from your wages.
Questions may be directed to:
FINANCE DIRECTOR
P.O. BOX 51530
BOWLING GREEN, KY 42102-5830
PHONE: (270) 842-7168 FAX: (270) 842-3411