FormW-4 (Rev. December 2020) Department of the Treasury Internal Revenue Service

Employee's Withholding Certificate Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS. (a) First name and middle initial Last name

- Does your name match the name on your social security card? # net to ensure you get credit for your earnings, contact SSA at 860-772-1213 or go to

Single or Married filing separately Marriad filing jointly or Qualitying Head of household (Check anly'é you're unmarried and pay more than haf the costs of kreping up home for yoursel and a qualitying individual)

Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step. who can claim exemption from withholding. when to use the estimator at www.irs.gow/W4App, and privacy. 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 al of these jobs. Multiple Jobs or Spouse Do only one of the following. Works (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3-4): or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding: or (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job

If your total 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 Multiply the number of other dependents by $500

Add the amounts above and enter the total here 3 (a) 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 s 4(a) (b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here 4(b)

(c) Extra withholding. Enter any additional tax you want withheld each pay period

Under penalties of perjury.1 declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

EmployersEmployor's name and address Only

For Privacy Act and Paperwork Reduction Act Notice, see page 3.