Form W-4

Form W-4
Employee's Withholding Allowance Certificate
First name and middle initial
Last name
Social security number
Home address (number and street or rural route)
City or town, state, and ZIP code
Marital Status

SingleMarriedMarried, but withhold at higher Single rate.
Note: If married filing separately, check "Married, but withhold at higher Single rate."
Check "yes" if your last name differs from that shown on your social security card. You must call 800-772-1213 for a replacement card.

Yes
Total number of allowances youre claiming ($)
Additional amount, if any, you want withheld from each paycheck ($)
Optional: I claim exemption from withholding for 2019, and I certify that I meet both of the following conditions for exemption.
1. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
2. This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
If you meet both conditions, write "Exempt" here
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.
Employees signature This form is not valid unless you sign it

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