CA EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE

CA EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE
Complete this form so that your employer can withhold the correct California state income tax from your paycheck.
Enter Personal Information
First, Middle, Last Name*
Social Security Number*
Address*
City, State, and ZIP Code*
Filing Status*

MARRIED (one income)HEAD OF HOUSEHOLDSINGLE or MARRIED (with two or more incomes)
Total Number of Allowances you’re claiming (Use Worksheet A for regular withholding
allowances. Use other worksheets on the following pages as applicable, Worksheet A+B
Additional amount, if any, you want withheld each pay period (if employer agrees), (Worksheet B and C)
Exemption from Withholding
I claim exemption from withholding for 2020, and I certify I meet both of the conditions for exemption. Write “Exempt” here
I certify under penalty of perjury that I am NOT SUBJECT to California withholding. I meet the conditions set forth under the Service Member Civil Relief Act, as amended by the Military Spouses Residency Relief Act and the Veterans Benefits and Transition Act of 2018.

(Check box only if you are NOT SUBJECT to CA withholding)
Under the penalties of perjury, I certify that the number of withholding allowances claimed on this certificate does not exceed the number to which I am entitled or, if claiming exemption from withholding, that I am entitled to claim the exempt status.
Employee Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: