Locally Funded Employment Form

Church or school treasurers should use this form to report the hiring or termination of a locally funded employee.

In addition to completing the Locally Funded Employment Form, you will need to submit an I-9, as well as State and Federal W-4 forms.

These forms are available on our Forms page, but please contact Treasury at 515.223.1197 x2123 for assistance before mailing them to ensure everything is filled out correctly.

Treasurer - Locally Funded Employment Form
First
Last
$
Your First and Last Name
xxx-xxx-xxxx
Provide your signature using a finger, stylus pen or mouse.