FOIA
CERTIFICATE OF NON-RESIDENCE IN THE DISTRICT OF COLUMBIA - MILLS, MONTRELL EUGENE
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001308854
Release Decision:
RIPPUB
Original Classification:
U
Document Page Count:
1
Document Release Date:
February 19, 2008
Sequence Number:
Case Number:
F-2005-00558
Publication Date:
November 20, 1959
File:
| Attachment | Size |
|---|---|
 DOC_0001308854.pdf | 35.36 KB |
Body:
Form D-4-A Government of the District of Columbia Income 6 Franchise Tax Division Washington 1, D. C. EMPLOYEE: Upon request off your employer, you must file this form with him so his records may show clearly that you are not a resident of the District of Columbia. Otherwise, he must withhold D. C. income tax from your wages. EMPLOYER: Keep this certificate with Your records. It you believe the " em- ployee should have filed Form D4 in lieu of Form D-4.A, the Assessor, D. C. should be so informed. CERTIFICATE OF NON-RESIDENCE IN THE DISTRICT OF COLUMBIA , (See instructions on reverse side) Montrell E I~La_s____----------- Social Security No __ t full name P s _____ rin ____ Print address _25223 Tde~_?^?toT~ -------- City ?'V??' -_---- State __eXas I, -----Montrell E Mills --------------_--___--_---_- , certify that: ---- ------------- -Name) My permanent residence is 262 Ws_NewtoilCircle ---------------------- (Street) - Irvingi R0_14 s2-2-_:x---- ----------------- (City) ---- - --- -------; that nty) (State) -- - City---- (County) (u I I dohave not not have a maintained place of a abode place of within abode the within District; that the District for more than seven (7) months during this calendar year; that I do not reside within the District; and that I am not domiciled within the District. I certify under the penalties provided by law that the above statement&are true, correct, f lt t th bstf knowledge and and compeeoee o my. 20 November 1959 ------------------------ - (Signature) ---------------- FOR RELEASE APPROVED DATE: NOV 2007
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