Employee Certification Of Residency Or Non Residency printable pdf download

Employee Certification Of Residency Or Non Residency

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.

♦

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

Employee Certification Of Residency Or Non Residency