ࡱ> #%"  bjbj "jjy lFFFFFFFZ8 Z V X X X X X X $ | F| FF (FFV V fV FFV  0*PZH.FV V 0 V mt|mV ZZFFFFSample Letter 10 Employee Tax Certification Letter Memorandum To: From: ,Agency Payroll Officer Subject: Employees Tax Certification Date: Tax Year: To recover over-collected social security and Medicare taxes paid in a prior calendar year, the Internal Revenue Services Publication 15, Circular E, Employers Tax Guide, requires your employer, the State of Tennessee, to obtain a signed statement certifying you have not requested, and will not request, a refund or credit from the IRS for the over-collected taxes. This memorandum serves as the required certification. By signing below, you are authorizing the State of Tennessee to correct your social security and Medicare tax records for the prior year and to receive a refund of excess taxes paid on your behalf, including the employers matching portion. If the State does not receive this signed statement from you; any over-collected taxes the State is unable to recover from the IRS may be considered a debt you owe the State of Tennessee. Thank you for your assistance in correcting your payroll records with the Internal Revenue Service and the Social Security Administration. Employees signature: _____________________________ Social Security Number: ____________________________ Department/Division: ______________________________ Date: ___________________________________________ FA-0944 .58Cy CJ CJOJQJ5CJOJQJ\ 5OJQJOJQJ .5678CDZ[23[\ $ !1$a$ !1$$a$$a$y   F G y  !1$ $ !1$a$ 1h/ =!"#$% i8@8 NormalCJ_HaJmH sH tH <A@< Default Paragraph Font: @: Footer !1$ CJaJh2"@2 Caption$a$ 5aJh,, Header  !.5678CDZ[23[\FGy00000000000000000000000000000000000 @0    xy[ip\xy3..bqx !xyyFinance & Administration2M:\Policy 11\EMPLOYEE TAX CERTIFICATION LETTER.docag05p132M:\Policy 11\EMPLOYEE TAX CERTIFICATION LETTER.docPatrice Steinhart2M:\Policy 11\EMPLOYEE TAX CERTIFICATION LETTER.docPatrice SteinhartDM:\Forms\Sample letters 113001\EMPLOYEE TAX CERTIFICATION LETTER.docPatrice SteinhartDM:\Forms\Sample letters 113001\EMPLOYEE TAX CERTIFICATION LETTER.docFinance & AdministrationKM:\Forms\Sample letters 113001\EMPLOYEE TAX CERTIFICATION LETTER 091003.docFinance & AdministrationKM:\Forms\Sample letters 113001\EMPLOYEE TAX CERTIFICATION LETTER 100103.docFinance & AdministrationRN:\Customer Support\Web\Production Working Files\F&A INTERNET\act\emp_tax_cert.doc@n`@UnknownGz Times New Roman5Symbol3& z Arial"hYy&Yy&jTWF 202Employee Tax Certification Finance & AdministrationFinance & AdministrationOh+'0  @L h t  Employee Tax Certification mplFinance & Administrationn inainaNormal Finance & Administrationn 2naMicrosoft Word 9.0a@F#@ @v@v՜.+,0 hp  STATE OF TENNESSEE  Employee Tax Certification Title  !$Root Entry F0 U&1Table WordDocument"SummaryInformation(DocumentSummaryInformation8CompObjjObjectPool0 U0 U  FMicrosoft Word Document MSWordDocWord.Document.89q