Out-of-State Income Tax Withholding Form

Complete this form if you will be working for the University for more than in a state other than California or if you wish to cancel state income tax withholding for another state. See Instructions.

INTERNET EXPLORER DOES NOT SUPPORT THIS FORM SUBMISSION. PLEASE COMPLETE THIS FORM IN A FIREFOX, SAFARI OR CHROME WEB BROWSER.


I began earning compensation in the state listed above
And expect to continue working in the state until approximately

I understand that I must complete a new Out-of-State Income Tax Withholding form when my assignment ends.


I began earning compensation in the state listed above on
and expect to continue working in this state until approximately

%
%
Employee Certification