Monaca, PA · Beaver County
Residency Certification Form
Employers and taxpayers use this form to report employee residence and employer information for local earned income tax collection and distribution.
What this form is
This form reports employee residence and employer information for the collection and distribution of local earned income taxes. Employers must use it when hiring a new employee or when a current employee reports a name or address change. It asks for employee and employer contact details, addresses, municipality, county, PSD codes, applicable tax rates, and the employee’s signature and date.
Who needs it
Employers use the form for new employees and when current employees notify them of a name or address change.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form has no notary block; the employee signs and dates the certification, and the document lists no sworn or notarized attachment.
How to submit this form
- 1
Download The Form
Download the Residency Certification Form PDF.
- 2
Complete The Information
Enter the requested employee and employer details, including addresses, municipality, county, PSD codes, and tax rates.
- 3
Review Attachments
The form does not list any attachments.
- 4
Sign And Date
Have the employee sign and date the certification.
- 5
Submit The Form
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who uses the Residency Certification Form?
- Employers use it for new employees and when current employees report a name or address change. It collects employee residence and employer information for local earned income tax purposes.
- What information does the form request?
- It asks for employee and employer names, addresses, contact details, municipality, county, PSD codes, applicable earned income tax rates, and the employee’s signature and date.
- Do I need a notary for the Residency Certification Form?
- No. This form has no notary block; the employee signs and dates the certification, and the document lists no sworn or notarized attachment.
- How do I submit the Residency Certification Form?
- The form does not give a submission address or department. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Residency Certification Form doesn’t need a notary — but if you have another Monaca form that does, a commissioned online notary can help.