Indiana > Statewide > Department Of Revenue > Sales And Withholding

Certificate Of Residence WH-47 - Indiana

Certificate Of Residence Form. This is a Indiana form and can be used in Sales And Withholding Department Of Revenue Statewide .
 Fillable pdf Last Modified 4/19/2007
Get this form for FREE as a print-only pdf

Form WH-47 SF# 9686 (R/12-97) Certificate of Residence This form is to be used only by residents of States with a reciprocal tax agreement.* Employer TID Number Street and City Address Social Security Number Indiana Employer's Name Employee Name The employee swears to be a legal resident of the State of , does not own personal property in Indiana, and understands that income from salaries, wages, tips and commissions received from Indiana sources are taxable in their state of residence and not subject to Indiana Adjusted Gross Income Tax as a result of the reciprocal tax agreement with the State of . Employee further states the Indiana employer will be advised of any change in legal residence. Note: The employee understands that the employer remains responsible for withholding any applicable Indiana County taxes. Date , Employee Signature day of Subscribed and sworn to before me, a Notary Public in and for said County and State, this , My Commission Expires . Notary Public Signature My County of Residence Do not send this form to the Indiana Department of Revenue it is to be filed with and held by the employer. *States that have reciprocal agreements with Indiana are: Kentucky, Michigan, Ohio, Pennsylvania and Wisconsin. American LegalNet, Inc. www.FormsWorkflow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. motion for continuance
  2. form interrogatories
  3. abstract of judgment
  4. Affidavit of Indigency
  5. VERIFICATION
  6. petition for summary administration
  7. order of protection
  8. case management statement
  9. default
  10. civil case cover sheet

Bookmark and Share