Nebraska Nebraska Employee Certificate for Allocation of Withholding Tax

Nebraska Employee Certificate for Allocation of Withholding Tax 
Form 9N
PRINT

RESET

Nebraska Nonresident Employee Certificate

FORM

9N

for Allocation of Income Tax Withholding
	 Employee’s Name			

Percent of Compensation Subject to	
Withholding

	 Mailing Address (Number and Street, or Rural Route and Box Number)		

Employer’s Name

	 City	

State	

Social Security Number

%

Zip Code	    Check this box if you are a nonresident military spouse whose income is not subject
to Nebraska tax.*

				
	 Under penalties of perjury,
I declare that I reside at the address shown above. I estimate that the above percentage of my compensation
from the employer with whom I file this certificate is for services subject to Nebraska income tax withholding. I will notify my employer
by filing another Form 9N within ten days after any substantial change in the proportion of my services subject to Nebraska income
tax withholding.

sign
here

	 I also understand that a nonresident individual who provides false information on Form 9N or an employer who knowingly
uses such false information may be penalized. Furthermore, penalties may be imposed if the false information results in an
amount withheld that is less than 75 percent of the employee’s Nebraska tax liability on the wages. This penalty may equal
the total tax evaded, and an additional penalty of up to $1,000 may be imposed.
Signature of Employee		

Date

Email Address		

Phone Number

Employee:	File this certificate with your employer. Do not send it to the Nebraska Department of Revenue.
Employer:	 Retain this certificate with your withholding tax records. You may withhold on the basis of this certificate, but you
must make any necessary adjustments during the year so that the proper amount is withheld from the employee.
*Note: Beginning with the 2018 tax year, the wages of the military servicemember’s spouse making the election to claim the
non‑Nebraska military servicemember’s state of legal residence for tax purposes are not subject to Nebraska tax.
For additional information see the Military Spouses and their Employers FAQs and the Nebraska Income Tax for U.S.
Servicemembers, Their Spouses, and Civilians Working with U.S. Forces information guide.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729

8-011-1967 Rev.   9-2021
Supersedes 8-011-1967 Rev. 12-2019