Pennsylvania Nonwithholding of PA Income Tax Application

Nonwithholding of PA Income Tax Application
Nonwithholding of PA Income Tax Application (REV-291)
(PT) 11-19 (FI)

REV-291

NONWITHHOLDING OF
PA INCOME TAX
APPLICATION
PURPOSE OF REV-291

Withholding Required. A partnership or PA S corporation is required to withhold Pennsylvania personal income tax on the PA-source
income of each nonresident partner, member or shareholder. Exception. A partnership or PA S corporation is not required to withhold
Pennsylvania personal income tax on income reported to a partner, member or shareholder that is one of the following and gives
the partnership or PA S corporation a completed and a signed REV-291, Nonwithholding of PA Income Tax Application:

•
•
•
•

• A clearing agency (or its nominee) or a broker or financial

A PA S corporation or other corporation

institution (or its nominee) that holds an interest in a
partnership or PA S corporation as a nominee on behalf of
one of the above.

A partnership or other unincorporated enterprise
A pension, profit-sharing or charitable trust

A resident individual, estate or trust
This application should be filed with the partnership or PA S corporation. Do not submit this form to the department.
SECTION I

START
➜

IDENTIFICATION

1a. Name of Beneficial Owner of Partnership or PA S corporation Interest

1b. Taxpayer Identification Number
9 DIGIT - NO DASH

1c. Permanent Street Address

City

State

ZIP Code

1d. Current Mailing Address, if Different than Permanent Address*

City

State

ZIP Code

1e. Withholding Agent (Enter Name of Partnership or PA S Corporation)

1f. Taxpayer Identification Number
9 DIGIT - NO DASH

1g. Current Mailing Address*

City

State

ZIP Code

*Include apartment or suite number or post office box if mail is not delivered to street address.

COMPLETE SECTION II OR SECTION III
SECTION II

CERTIFICATION BY BENEFICIAL OWNER

The beneficial owner of an interest in the withholding agent is (mark applicable oval):
A PA S corporation or other corporation
A pension, profit-sharing or charitable trust, a business trust, a partnership or other unincorporated enterprise
A resident individual, estate or trust

SECTION III

CERTIFICATION BY NOMINAL OWNER

3a. Name of Nominal Owner of Partnership or PA S Corporation Interest
3c. Current Mailing Address*

3b. Taxpayer Identification Number
9 DIGIT - NO DASH

City

State

ZIP Code

*Include apartment or suite number or post office box if mail is not delivered to street address.
3d. The nominal owner holds its interest in withholding agent as a nominee on behalf of the beneficial owner.
The beneficial owner is (mark applicable oval):
A PA S corporation or other corporation
A pension, profit-sharing or charitable trust, a business trust, a partnership or other unincorporated enterprise
A resident individual, estate or trust

SECTION IV

REVOCATION OR TERMINATION OF PRIOR WITHHOLDING EXEMPTION CERTIFICATE

Mark this oval if you are revoking a prior Nonwithholding of PA Income Tax Application.

Under penalties of perjury, I certify that to the best of my knowledge and belief the information on this form is correct.
Print or Type Name of Beneficial Owner or Authorized Representative Signature

Please Sign Your Return after printing.

Reset Entire Form

Date

MM/DD/YY

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