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PA REV-419 exemption certificate

PA REV-419 exemption certificate


PA REV-419 exemption certificate



  • Paper: Letter (8.5in x 11in)
  • Copies to print: 2
    • Employers must keep a copy for their records.
    • Employees claiming military spouse exemption must attach a copy of the following documents:
      • The employee's current Military Spouse ID card.
      • The servicemember's current current Military Orders.
    • Employees must notify the employer within 10 days if they wish to revoke their exemption.


  • The employee is eligible for military spouse exemption if they meet the following conditions:
    • the spouse is a member of the armed forces present in PA in compliance with military orders.
    • the employee is present in PA solely to be with their spouse.
    • the employee and their spouse both maintain the same domicile in another state.
  • Employees that are a resident of Indiana, Maryland, New Jersey, Ohio, Virginia, and West Virginia may claim exemption from Pennsylvania withholding tax.
  • Employees must submit this form annually to retain their exemption.
  • To be used by employees to file exemption from state withholding tax.
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