Yes. Check the boxes that apply.
I’m unsure whether you should check the box about being a resident of a reciprocal state. It depends on where you worked. Pennsylvania and Maryland have reciprocity, but that question refers to living in MD while working in PA. If you worked in MD while living in MD and worked in PA while living in PA you don’t have to check that box.
PA also has reciprocity with Virginia. If you worked in VA while living in PA, then check the box.
PA wants copies on any W-2s that have tax withheld for another state while you were living in PA.
Your statement should list the amounts and payors of the compensation along with the total amount reported on Line 1a of the PA-40.
Your statement should also explain the difference between Medicare and PA wages. In your case it would be because you were a part year resident.
As a guide use instructions for the PA W-2 Reconciliation Worksheet.
You can upload your information: Do I need to mail any forms to the Pennsylvania Department of Revenue – for example, my W-2, W2-G, 1...
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