Westmoreland: e-Forms and e-Publications

{Westmoreland County, Pennsylvania}

{Keyword Search}

{Subject Search}

    Forms

     Provides access to official online forms and
     publications that can be filled in, printed

     out or downloaded.

Instructions
This page of the County's website provides access to electronic versions of official forms and publications. All of the documents listed on this page use the Adobe Acrobat technology and therefore require the Acrobat Reader for viewing. If you do not already have the viewer, click the Adobe logo to download the reader.

{Click Here to Download the Adobe Acrobat Reader}

To Print

Locate the desired form on the page.
Select the form by clicking the "Open" button to the left of the form name.
A new browser window will be displayed.
Select the "File" menu from the top left of the screen and select the "Print" option.
Select the desired printer and click "OK".
Click the back button on the browser to return to the forms page.

To Download

A new browser window will be displayed.
The new window will include a toolbar for Adobe Acrobat.
Select the "Save a Copy of the File" option. This option has an icon that looks like a
diskette.
A dialog box will be displayed prompting for the location and filename of the file, enter this information and click "OK".
Click the back button on the browser to return to the forms page

CONTROLLER (Payroll Forms)

Access Form Name Size Form Description

Change of Withholding (IRS Form W4)

228K

Earned Income Credit (IRS Form W5) 275K

Direct Deposit - Start 17K

Direct Deposit - Stop 15K

Request to Withhold Earned Income Tax (WAGE)

2010 Payroll Dates

AFLAC FlexOne Claim Form 21K

CONTROLLER (Retirement Forms)     All County Forms/Top

Access Form Name Size Form Description

Explanation of Retirement Benefits

38K

Designation of Beneficiary

60K

Change in Contribution Rate
16K

Change of Withholding-Pension (IRS form W-4P)

261K

CONTROLLER (Employee Reimbursements) All County Forms/Top
Access	Form Name	Size	Form Description
	Expense Reimbursement Voucher (Letter Size)	36K
	Meal Allowance Form	5K
	Seminar Request Form	20K
	Seminar Expense Form	13K
	Request for Taxpayer I.D. and Certification (IRS Form W-9)	28K

CORONER All County Forms/Top
Access	Form Name	Size	Form Description
	Coroner Guidelines	24KB
	Survivor's Guide	468KB

COURT ADMINISTRATION (Civil Forms) All County Forms/Top

Access	Form Name	Size	Form Description
	Certificate of Readiness	4K	Word Document
	Civil Court Application for Continuance	7K
	Cover Sheet	243K	Word Document
	New Cover Sheet Effective 5/26/2010		pdf
	New State Cover Sheet Effective 05/26/2010		pdf
	License Suspension Appeal		Word template
	License Suspension Appeal Nunc Pro Tunc		Word template
	License Suspension Appeal Supersedeas		Word template
	License Suspension Appeal Vehicle Registration		Word template
	Notice of Appeal from Award of Board of Arbitration	33K
	Praecipe for Arbitration	46K

COURT ADMINISTRATION (Criminal Forms) All County Forms/Top
Access	Form Name	Size	Form Description
	A.R.D. Petition	8K	Word Document
	Court Arraignment Notice	125K
	Criminal Court Continuance	10K
	Guilty Plea Petition	16K	Word Document
	Notice of Appearance	6K
	Official Court Arraignment Form	13K
	Petition for Probation Without Verdict	17K
	Waiver of Arraignment, Entry of Plea, and Entrance of Appearance	25K
	Waiver of Trial by Jury	5K

COURT ADMINISTRATION (Orphan Forms) All County Forms/Top
Access	Form Name	Size	Form Description
	Plenary Guardianship Order		Word Document
	Emergency Guardianship Order		Word Document
	Adoption Petition	131K	Word Template
	Adoption - Confirmed Consent Petition	123K	Word Template
	Adoption - Involuntary Termination Petition	134K	Word Template
	Adoption - Voluntary Relinquishment Petition	154K	Word Template
	Adoption - Report of Intent to Adopt	44K	Word Template
	Adoption - Report of Intermediary	55K	Word Template
	Estate - Petition for Distribution	81K	Word Template
	Estate - Decree for Distribution	35K	Word Template
	Estate - Certificate of Award of Real Estate	35K	Word Template
Link to PA Unified Judicial System Orphan Court Forms
	Mental Health Notice	6K

COURT ADMINISTRATION (Custody) All County Forms/Top
Access	Form Name	Size	Form Description
	Custody Pro Se Packet		Word Template
	Custody Request for Pretrial Form		Word Template
	Custody Pretrial Narrative		Word Template
	Custody Modification Petition and Order		Word Template
	Petition Contempt		Word Template

DOMESTIC RELATIONS (General Forms) All County Forms/Top
Access	Form Name	Size	Form Description
	Authorization for Release of Information	21K
	Direct Deposit Enrollment	243K
	Family Violence Indicator	24K
	Income and Expense Statement	479K
	Intake Information Questionnaire/Data Sheet	231K
	Obtaining a Telephone Support Conference/Hearing	33K
	Petition for Modification of an Existing Support Order	35K	Instructions (PDF)
	Poverty Affidavit	366K
	Unreimbursed Medical Expense	12K

ELECTIONS (General Forms) All County Forms/Top
Access	Form Name	Size	Form Description
	Absentee Ballot	106K
	Campaign Expense Report (under $250.00)	42K
	Campaign Expense Report (over $250.00)	1.39MB
	Voter Registration Form

HUMAN RESOURCES All County Forms/Top
Access	Form Name	Size	Form Description
	Employment Application	379Kb

JUVENILE PROBATION (Court Forms) All County Forms/Top
Access	Form Name	Size	Form Description
	Colloquy		Word Document
	Complaint Form		.pdf fill-in form
	Juvenile Cont Before Judge Detained		Word Document
	Juvenile Cont Before Judge (Not Detained)		Word Document
	Juvenile Remain Detained Due Cont		Word Document
	Public Defender Application		.pdf fill-in form
	Waver of Time Limit		Word Document

SHERIFF (General Forms) All County Forms/Top
Access	Form Name	Size	Form Description
	Gun Permit Application	2.24MB
	New Applicant Instructions	24K
	Renewal Application Instructions	25K

TAX ASSESSMENT

Access	Form Name	Size	Form Description
	Annual Assessment Appeal Form	1.2MB
	Assessment Exemption Application Form	1MB
	Change in Assessed Value Appeal Form	12K
	Homestead Exclusion Application and Instructions	90K
	Rules of Assessment Appeal Procedure	40K

TREASURER All County Forms/Top
Access	Form Name	Size	Form Description
	Bingo License	727K
	Bingo - Special Permit	169K
	Dog License - Disabled - Senior PLEASE INCLUDE A SELF-ADDRESSED STAMPED ENVELOPE	300K
	Dog License - Lifetime (For use in Westmoreland County only). PLEASE INCLUDE A SELF-ADDRESSED STAMPED ENVELOPE.	85K
	Dog License - Regular PLEASE INCLUDE A SELF-ADDRESSED STAMPED ENVELOPE	623K
	Raffle - Special Permit	87K
	Small Games of Chance	402K

VETERAN'S AFFAIRS All County Forms/Top
Access	Form Name	Size	Form Description
	Disabled Veteran Real Estate Exemption Program	735K	Application for exemption from Real Property Taxes MA-VA Form 40/41
	Application for Disabled Veteran, Severely Disabled Veteran Registration Plate or Severely Disabled Veteran Motorcycle Plate Decal	73K	Pennsylvania Department of Transportation Application Form MV-145V
	Application for Memorial Day or Veterans Day Expenses	380K
	Application for VA Medical Benefits	Link to instructions and on-line form	Veteran's Affairs Form 10-10EZ
	Health Benefits Renewal Form		Veteran's Affairs Form 10-10EZR
	Presidential Memorial Certificates	Link to instructions and on-line form	Veteran's Affairs Form 40-0247
	Application for Standard Government Headstone or Marker		Veteran's Affairs Form 40-1330
	Application for Special US Military Registration Plate	31K	Pennsylvania Department of Transportation Application Form MV-150
{Open}	Application for Federal Burial Benefits	Link to instructions and on-line form	Veteran's Affairs Form 21-530
{Open}	Burial Application	1177K	Application for Burial Allowance-War Veteran-County of Westmoreland
{Open}	Headstone Application	1379K	Application for Headstone for a Deceased Service Person's Grave
{Open}	Widow's Burial Application	512K	Application for Burial Expenses of a Deceased Service Man's Widow
{Open}	Burial at Sea Application		Application for Burial at Sea and Instructions

Weights and Measures All County Forms/Top

Access Form Name Size Form Description

Device Licensing Application

Use this form to notify Weights & Measures of new or recently repaired devices within 48 hours of the installation or repair.

Mail with registration fee to:

Bureau of Weight & Measures

194 Donohoe Road

Greensburg, PA 15601

You must also notify W&M

by phone: 724.830.3980

Content Last Modified on 8/14/2009 3:23:12 PM

Do you have questions about Westmoreland County Government? Email us.

Home / Site Map / Site Feedback / Show Images / Site Tools / Privacy Policy

Technical problems with our site? Email our Webmaster.