Duquesne University - Payroll Department
Authorization for Local Tax Withholding -- Full Time Employees Only
Please check the appropriate box:
Change in Locality
Employee information (Please Print):
Last 4 Digits of your Social Security Number
School District School District
Tax % Tax %
Dates of Occupancy Dates of Occupancy
I hereby authorize Duquesne University to withhold local taxes for the above named locality. I understand that
Duquesne University will submit quarterly payments on my behalf to my local tax authority at the percentage listed. I
will also complete a new Authorization for Local Tax Withholding form and return it to Payroll within 5 days should any
modifications occur from the information provided such as change of address or and adjustment to my tax percentage.
I hereby authorize Duquesne University to retroactively deduct taxes for the current quarter.
Once completed, please print document and return to the Payroll Department via interoffice mail .
Please do NOT send this document via email because it contains your security information.
If you are not on campus, please send the document via postal mail to the following address :
Room 202 Administration Building
600 Forbes Ave
Pittsburgh, PA 15282
***************(Official Use Only)***************
Effective Pay Date: