W-4 : Employee’s Withholding Certificate

Employee’s Withholding Certificate

Form W-4
Original Document

You are encouraged to review the original document prior to completing this form. Your answers will be embedded on the PDF form and submitted to the proper department.
Step 1: Enter Personal Information
(a) First name and middle initial
Last name
Address
City or town, state, and ZIP code
(b) Social security number
(c)

Single or Married filing separatelyMarried filing jointly or Qualifying widowerHead 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.)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.
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.)
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.

Do only one of the following.

(a)Reserved for future use.

(b)Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; 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 generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate
TIP: If you have self-employment income, see page 2.
Step 3: Claim Dependents
If your income will be $200,000 or less ($400,000 or less if married filing jointly):
3(a) Multiply the number of qualifying children under age 17 by $2,000 :
3(b) Multiply the number of other dependents by $500 :
3. Add the amounts above and enter the total here:
Step 4: Other Adjustments

(Optional)
Other
include interest, dividends, and retirement income .
4(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.
4(b) Deductions:
If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deduction Worksheet on page 3 and enter the result here.
4(c) Extra withholding:
Enter any additional tax you want withheld each pay period.
Step 5: Sign Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it
Signature

Clear
Date
Date*

MonthDayYear
Date
Employer Name and Address
Gentry Public Schools
201 S Giles Ave
Gentry, Arkansas 72734
EIN
Should be Empty:

Employee’s Withholding Certificate

Original Document

Step 1: Enter Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependents

Step 4: Other Adjustments

Other

Step 5: Sign Here

Date