W4 Form/ Employee’s Withholding Certificate

W4 Form/ Employee’s Withholding Certificate
This form is developed and released by the Department of the Treasury Internal Revenue Service.

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Your withholding is subject to review by the IRS.
Step 1: Enter Personal Information
Name *

First Name Middle Name Last Name
Social security number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please select your filing status. *

Single or Married filing separately Married filing jointly or Qualifying widower Head of household Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual
Step 2: Multiple Jobs or Spouse Works
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Check this box if this statement applies to you.
Step 3: Claim Dependents

If your income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000. *
Please multiply the number of dependents that you claim on your tax return aged 17 years of age or younger by $2,000.00 and place that number here. If this does not apply to you, please tier $0.00.
Multiply the number of other dependents by $500. *
Please multiply the number of dependents that you claim on your tax return aged 17 years of age or younger by $500.00 and place that number here. If this does not apply to you, please tier $0.00.
Total Dependents *
Step 4 (Optional)

This section is optional and includes scenarios that not many individuals often have with their taxes. If the question does not apply to you, please just enter zero in the box.
Other Income (Not From Jobs) *
If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.
Deductions *
If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet and enter the result here. (Deduction Worksheet available by request by your immediate supervisor.)
Extra Withholding *
Enter any additional tax you want withheld each pay period.
Step 5: Employee Signature
Under penalties of perjury, I declare this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Signature *

Clear
Date of Signature *

Month Day Year
Please enter today's date in this field.
State of Residence *
Please enter the state that you reside in this field.
Should be Empty:

W4 Form/ Employee’s Withholding Certificate

Step 1: Enter Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependents

Step 4 (Optional)

Step 5: Employee Signature