FS Form 7311 Department of the Treasury | Bureau of the Fiscal Service Revision June 2017
EMPLOYEE’S WITHHOLDING CERTIFICATE
FOR LOCAL TAXES CITY OR COUNTY
1. FULL NAME 2. SOCIAL SECURITY NO. 3. AGENCY USE
4. HOME ADDRESS (STREET, NUMBER, CITY, COUNTY, STATE AND ZIP CODE)
5. DEPARTMENT - AGENCY - OFFICE 6. PLACE OF EMPLOYMENT (CITY, COUNTY, STATE) 7. MARITAL STATUS
SINGLE MARRIED
SEE INSTRUCTIONS BELOW
8. (CHECK PROPER BOX)
CITY OR COUNTY EMPLOYED RESIDENT NON RESIDENT
IF YOU ARE NOT SUBJECT TO LOCAL TAXES
CHECK HERE AND EXPLAIN BELOW
9. (CHECK PROPER BOX)
IF YOUR RESIDENCE IS NOT IN THE SAME STATE AS
YOUR REGULAR PLACE OF EMPLOYMENT
DO YOU CONSENT TO WITHHOLDING YES NO
10. I ESTIMATE THAT ______ % OF MY ANNUAL COMPENSATION IS FOR SERVICES PERFORMED OUTSIDE THE CITY OR COUNTY
11. TOTAL NUMBER OF EXEMPTIONS (IF APPLICABLE) 12. OTHER ALLOWANCES (IF APPLICABLE)
13. I CERTIFY THE INFORMATION SUBMITTED ON THIS CERTIFICATE IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
SIGNATURE: REVIEWED BY:
The social security number is required under the authority of Executive Order 9397 to provide taxpayer identification. The other
information is required under the provisions of 5 U.S.C. 5520, Executive Order 11997, dated June 22, 1977, and 31 CFR 215 for the
purpose of implementing a Federal agreement with the city or county concerned relating to withholding of local income or employment
taxes pursuant to a city or county ordinance. The information provided will be disclosed to local officials to assure the taxpayer’s
account has been properly credited for the amounts withheld. Failure to provide the information requested may affect determination of
the proper amount to be withheld.
INSTRUCTIONS
This certificate is to be filed with your employer to be used as the basis to (1) either withhold or not withhold local taxes and (2)
determine the proper amount to be withheld. A new certificate should be filed whenever your tax status changes. Failure to submit this
form will result in the maximum withholding if you are employed in or reside in the city or county.
EXPLANATION OF CERTAIN ITEMS
Item 8. – If the local ordinance contains a provision which exempts you from the local tax, you should complete this item by placing a
check mark in the box to indicate that you are not subject to the tax, and explain below.
I am NOT subject to the local tax and tax withholding because:
Item 9. – Out of State employees. Local taxes will not be withheld from your compensation if you are not a resident of or are not
employed in the State in which the city or county located, unless you consent to the withholding. If you are subject to the local tax, you
must indicate either that you do, or do not, consent to withholding by checking the proper box.
Item 10. – Based on the local ordinance you may be liable for taxes only on compensation paid for service performed within the city or
county. If so, and if you perform some part of your services outside the city or county, away from your regular place of employment, the
amount to be withheld from your compensation may be reduced to approximate your actual tax liability by completing this item with an
estimate of the percentage of your total compensation paid which is for services performed outside the city or county. Your withholding
will be adjusted only where a substantial amount is involved, i.e. 25%, or more of your services are performed outside the city or county.
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