Pennsylvania Form REV-419 — Employee’s Nonwithholding Application Certificate

Get the blank Form REV-419 (PDF)  ·  Checked line by line against the official Pennsylvania form, last verified September 8, 2026  ·  How we verify

What is Form REV-419?

Form REV-419, the Employee’s Nonwithholding Application Certificate, tells your employer not to withhold Pennsylvania personal income tax from your wages. Pennsylvania’s default rule is that every employer withholds PA income tax on compensation paid for work in the state. REV-419 is the documented exception: by signing it, you certify under penalty of perjury that you did not owe PA income tax last year and/or do not expect to owe it this year, for one of the specific reasons the form lists.

The form collects your identifying information, the reason you are exempt, the tax year involved, and — for reciprocal-state and servicemember-spouse claims — your state of legal residence. It exists so the employer has written authority to change withholding and so the Department can review questionable claims. Completing it correctly matters because an incorrect certificate leaves you underwithheld: if you actually owe PA tax, you will face a bill plus possible penalties and interest when you file your PA-40.

Who Must File Pennsylvania Form REV-419?

You file REV-419 if you want PA personal income tax withholding stopped and you fit one of these situations:

PA Tax Forgiveness (Box a). You qualify if you had a right to a full refund of all PA income tax withheld last year because you owed nothing under the Special Tax Provisions of section 304 of the Tax Reform Code, and/or you expect the same this year. Lower-income workers and retirees are the typical claimants.

Resident of a reciprocal state (Box b). You live in Indiana, Maryland, New Jersey, Ohio, Virginia, or West Virginia and work in Pennsylvania. Under the reciprocal agreements your wages are taxed by your home state, and your employer withholds that state’s tax instead of PA’s.

Servicemember’s spouse (Box c). Under the Servicemembers Civil Relief Act, as amended, your PA wages are exempt if your spouse is a servicemember present in PA under military orders, you are in PA solely to be with your spouse, and you and your spouse both keep a domicile in another state. See PA Personal Income Tax Bulletin 2010-01.

Who does not file it. If you expect to owe any PA income tax, you are not eligible and should let normal withholding continue. A person who qualifies for complete Tax Forgiveness still must file a PA-40 with Schedule SP to claim it, even after filing REV-419.

How to File Pennsylvania Form REV-419

Give the completed, signed form to your employer — REV-419 goes to the employer, not to the Department of Revenue. File it as soon as you know you qualify.

• Filing method: Paper only. Photocopies are acceptable. There is no way to submit it electronically; a fill-in PDF is available from the Department’s website, but the signed certificate goes to your employer.
• Multiple jobs: File a separate REV-419 with each employer.
• Attachments for a servicemember’s-spouse claim (Box c): Include a copy of your spouse’s military ID card and current military orders.
• What the employer does: Keeps the form, adjusts withholding, and forwards a copy to the Department only in the situations listed on the form.

Before you start, have your Social Security number, your employer’s name and address, the tax year, and — for a Box b or Box c claim — your state of legal residence (and, for Box b, which reciprocal state).

When to Submit Pennsylvania Form REV-419

Form REV-419 has no annual filing deadline with the state, but its timing rules matter:

• Submit it as soon as you qualify. Give the completed certificate to your employer once you determine you are entitled to nonwithholding, so it takes effect before the next payroll you want it to affect. Withholding is not adjusted retroactively.
• Refile every year for a Tax Forgiveness claim. If you claim under Box a, file a new REV-419 for each year you remain eligible.
• Reciprocal-state residents do not refile annually. Once on file, a Box b certificate stays in effect unless your state of residence changes.
• New employer, new certificate. File a separate REV-419 with each employer, at the start of that employment.
• Revocation within 10 days. If your situation changes and you anticipate you will owe PA income tax for the year, notify your employer in writing within 10 days.
• If you submit it late or not at all, your employer withholds PA income tax at the normal rate for the pay periods before the certificate is on file; you recover any overwithheld amount by filing your PA-40.

Where to Send Pennsylvania Form REV-419

You do not mail REV-419 to the Pennsylvania Department of Revenue. Give the signed original to your employer, who keeps it with their payroll records.

• The employer forwards a copy (with any attachments) to: PA Department of Revenue, Bureau of Individual Taxes, PO Box 280507, Harrisburg, PA 17128-0507 — but only when a condition on the form applies: the employer has reason to believe the certificate is incorrect; the PA taxable gross compensation of an employee who claimed exemption under Box a (Tax Forgiveness) exceeds $1,625 for any quarter; the employee claims reciprocal-state residency (Box b), so the employer agrees to withhold the other state’s tax; or the employee claims the servicemember’s-spouse exemption under the SCRA (Box c).
• Attachments: A Box c (servicemember’s spouse) claim must include a copy of the spouse’s military ID card and current military orders.
• No e-filing. REV-419 is a paper certificate; photocopies are acceptable. A fill-in PDF is available from the Department’s website at pa.gov.

How to Complete Pennsylvania Form REV-419 Line by Line

The REV-419 instructions walk through the certificate in the order the fields appear; this section does the same, in plain English.

Employee Information

Employee name (first, middle initial, last): Enter your full legal name as it appears on your Social Security card.

Social Security Number: Enter your nine-digit SSN. This links the certificate to your PA tax account.

Telephone number: Enter a daytime number where you can be reached about the certificate.

Street address, city, state, ZIP: Enter your current home address. For a reciprocal-state claim, this should be your address in that state.

Tax year: Enter the year the certificate applies to. It is not necessary if you are checking Box b (reciprocal state), which does not expire annually.

Reason for Claiming Exemption

Check the one box that describes why you expect to owe no PA personal income tax. The form has three options.

Box a — Tax Forgiveness. Check this if you qualified for Tax Forgiveness of your PA personal income tax last year and had a right to a full refund of all PA tax withheld, and/or you expect to qualify this year and expect a right to a full refund. This one box covers both the prior-year and current-year situations.

Box b — Resident of a reciprocal state. Check this box, then check the one state you live in — Indiana, Maryland, New Jersey, Ohio, Virginia, or West Virginia. You are claiming exemption from PA withholding under that state’s reciprocal agreement with Pennsylvania and authorizing your employer to withhold your home state’s income tax on your PA wages instead.

Box c — Servicemember’s spouse (SCRA). Enter the state where you are a legal resident. You are certifying that you are not subject to PA withholding because you meet the requirements of the Servicemembers Civil Relief Act, as amended, as set forth in PA Personal Income Tax Bulletin 2010-01.

Certification and Signatures

Employee signature and date: Sign and date under penalty of perjury; print the form before signing. Your signature certifies you did not incur PA income tax liability in the prior year and/or do not expect to this year for the reason checked.

Employer name and Federal Employer Identification Number (FEIN): Your employer enters their legal business name and nine-digit FEIN.

Business address, city, state, ZIP, telephone: Your employer’s business contact information.

Employer’s signature: Your employer signs to acknowledge the certificate.

Employee’s quarterly compensation: Your employer enters your PA taxable gross compensation for the quarter. It is not required if you checked Box b or Box c. It matters for a Box a (Tax Forgiveness) claim, because the employer must send the certificate to the Department if this exceeds $1,625 for any quarter.

Common Mistakes to Avoid

• Sending it to the state. REV-419 goes to your employer; only the employer forwards a copy, and only in the listed situations.
• Forgetting to refile. A Tax Forgiveness claim (Box a) needs a new REV-419 every year.
• Claiming exemption while still owing PA tax. If you will owe any PA income tax you do not qualify, and you will face penalties and interest.
• Checking more than one reason box. Check the single box that applies.
• Leaving the state blank on a Box b or Box c claim. Both must identify your state of legal residence (and Box b, which reciprocal state).
• Not attaching military documents. A Box c claim needs the spouse’s military ID and current orders.
• Assuming REV-419 replaces your return. If you qualify for Tax Forgiveness you still file a PA-40 with Schedule SP to claim it.
• Not revoking when your situation changes. Notify your employer in writing within 10 days once you anticipate owing PA tax.

Frequently Asked Questions

Do I have to file REV-419 every year? For a Tax Forgiveness claim (Box a), yes. Reciprocal-state residents (Box b) do not refile each year unless their state of residence changes.

Where do I send REV-419? To your employer, not the Department of Revenue.

Can REV-419 be filed electronically? No. It is a paper certificate; photocopies are accepted.

What happens if I don’t file it? Your employer withholds PA income tax at the normal rate. If you were entitled to nonwithholding, you recover the money by filing your PA-40.

I live in New Jersey and work in Pennsylvania — does this form help? Yes. New Jersey is a reciprocal state, so you check Box b and NJ, and your employer withholds New Jersey tax instead of PA tax. Local wage taxes are separate and not covered by REV-419.

Does REV-419 stop local earned income tax? No. It only addresses Pennsylvania state personal income tax withholding.

How do I cancel REV-419? Give your employer written notice within 10 days of the point you anticipate owing PA income tax for the year.

I qualify for Tax Forgiveness. Do I still file a PA return? Yes — a PA-40 with Schedule SP, even if you filed REV-419.

Final Review Before Filing

• You fit one specific reason: Tax Forgiveness, reciprocal-state residency, or servicemember’s-spouse status.
• Only one reason box is checked.
• Your name matches your Social Security card and your SSN is correct.
• The tax year is entered (not needed only if you checked Box b).
• For Box b: the single reciprocal state you live in is checked.
• For Box c: your state of legal residence is entered, and the spouse’s military ID and current orders are attached.
• The form is printed, then signed and dated.
• Your employer completed their section (name, FEIN, address, signature).
• For Box a: quarterly compensation is entered.
• You kept a copy for your records.
• You have a reminder to refile next year if you claimed Tax Forgiveness.
• You are using the current REV-419 (EX 09-20) from the PA Department of Revenue.

General information from the official form and its instructions, not advice for your circumstances. See the full disclaimer.