Wisconsin WT-4 Form

Employee's Wisconsin Withholding Exemption Certificate/New Hire Reporting
You can view a blank copy of the Wisconsin W-4 here. Complete the fields below and click submit to send to Corporate and your Management staff.
Employee's Section (Print clearly)
Employees legal name (first name, middle initial, last name)*
Ex. Jonathan F Doe
Employees address (number and street)*
123 N Main St
City*
State*
Zip code*
Email Address*
example@example.com
Social Security Number*
Date of Birth*

MonthDayYear
Date of Hire*

MonthDayYear
Date
SingleMarriedMarried, but withhold at higher Single rate (Note: If married, but legally separated, check the Single box.)
FIGURE YOUR TOTAL WITHHOLDING EXEMPTIONS BELOW

Complete Lines 1 through 3
1. (a) Exemption for yourself - enter 1*
1. (b) Exemption for your spouse - enter 1*
1. (c) Exemptions for dependents - you are entitled to claim an exemption for each dependent*
1. (d) Total - add lines a through c*
2. Additional amount per pay period you want deducted (if your employer agrees)
3. I claim complete exemption from withholding (see instructions) - Enter "Exempt"
I CERTIFY that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled. If claiming complete exemption from withholding, I certify that I incurred no liability for Wisconsin income tax for last year and that I anticipate that I will incur no liability for Wisconsin income tax for this year.
Signature*
Date*

MonthDayYear
Should be Empty:

Employee's Wisconsin Withholding Exemption Certificate/New Hire Reporting