Fillable Certificate of Non-residency (USPTO)

Fill Online, Printable, Fillable, Blank Certificate of Non-residency (USPTO) Form

Use Fill to complete blank online USPTO (DC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Certificate of Non-residency (USPTO)

On average this form takes 3 minutes to complete

The Certificate of Non-residency (USPTO) form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 7 other fields

Country of origin: US
File type: PDF

U.S.A. forms for USPTO

BROWSE USPTO (DC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Certificate of Non-residency
This form is to be used only to waive state taxes based on the duty station reflected in the
Human Resources (HR) database.
Employee Name: __________________________________________________________
Residence Address: __________________________________________________________
__________________________________________________________
Social Security Number: ______________________________________________________
I certify that I have a temporary telework agreement due to the agency's mandatory telework
status. I want to waive state taxes for __________________________________________because I reside
and work in the state of __________________________________________.
I will submit a state tax form to HR, unless I reside in a state where I’m not subject to state
taxes. States not subject to state taxes are Alaska, Florida, Nevada, New Hampshire, South
Dakota, Tennessee, Texas, Washington, and Wyoming. My state tax form is attached to this
Certificate of Non-residency.
Employee Signature: __________________________________________________________
Date: __________________________________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Certificate of Non-residency (USPTO)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 November 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document