2405 - PA Certificate of Residency

This form is mandatory for all staff working and living in Pennsylvania. A copy of the form must be kept in Payroll records.​​

​Employees are to enter both home and work address, along with current PSD codes and tax rates. Payroll will withhold the higher of the two. Please send to: Young Life, Attn: Payroll, PO Box 520, Colorado Springs, CO 80901-0520.