Wisconsin WT-4

Employee’s Wisconsin Withholding Exemption Certificate/New Hire Reporting
To view a copy of this W4 click the link below.

Wisconsin WT4
W T- 4

Employee’s Section (Print clearly)
Employee’s legal name (first name, middle initial, last name)*
Your Email*
Social security number*
Employee’s address (number and street)*
Date of birth*

MonthDayYear
City*
State*
Zip code*
Date of hire

MonthDayYear
Date
Note: If married, but legally separated, check the Single box.

SingleMarriedMarried, but withhold at higher Single rate.
FIGURE YOUR TOTAL WITHHOLDING EXEMPTIONS BELOW
1.(a) Exemption for yourself – enter 1
(b) Exemption for your spouse – enter 1
(c) Exemption(s) for dependent(s) – you are entitled to claim an exemption for each dependent
(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.
Date Signed*

MonthDayYear
Signature*

Clear
Should be Empty:

Employee’s Wisconsin Withholding Exemption Certificate/New Hire Reporting