Instruction's for completing:
1. NUMBER OF EXEMPTIONS – (Husband and/or Wife) Do not claim more than the correct number of exemptions. However, if you ex- pect to owe more income tax for the year, you may increase your with- holding by claiming a smaller number of exemptions and/or dependents, or you may enter into an agreement with your employer to have additional amounts withheld. This is especially important if you have more than one employer, or if both husband and wife are employed.
2. DEPENDENTS – To qualify as your dependent (line 1 on the re- verse side), a person must (a) receive more than 1/2 of their support from you for the year, (b) not be claimed as a dependent by such person’s spouse, (c) be a citizen or resident of the United States, and (d) have your home as their principle residence and be a member of your house- hold for the entire year or be related to you as follows: son, daughter, grandchild, stepson, stepdaughter, son-in-law or daughter-in-law; Your father, mother, grandparent, stepfather, stepmother, father-in-law or mother-in-law; Your brother, sister, stepbrother, stepsister, half-brother, half-sister, brother-in-law or sister-in-law; Your uncle, aunt, nephew or niece (but only if related by blood).
3. CHANGES IN EXEMPTIONS OR DEPENDENTS – You may file a new certificate at any time if the number of exemptions or depen- dents INCREASES. You must file a new certificate within 10 days if the number of exemptions or dependents previously claimed by you DE- CREASES for any of the following reasons:(a) Your spouse for whom you have been claiming an exemption is divorced or legally separated, or claims his or her own exemption on a separate certificate, or(b) The support of a dependent for whom you claimed an exemption is expected to be less than half of the total support for the year.OTHER DECREASES in exemptions or dependents, such as the death of a spouse or a dependent, do not affect your withholding until next year, but require the filing of a new certificate by December 1, of the year in which they occur. 4. Claim additional amounts of withholding tax if desired. This will ap- ply most often when you have income other than wages. 5. You qualify for the low income tax rates if your total income from all sources are as shown below:(a) Single $7,800 to $11,400(b) Married filing jointly $15,500 to $16,200(c) Head of Household $12,100 to $16,200 For more information on how to fill out this form, please click on the following link.