PDN Alabama State Withholding Form

Alabama State Form A4
ALABAMA DEPARTMENT OF REVENUE

This section is to complete your State of Alabama tax withholdingsform
Employee’s Withholding Tax Exemption Certificate
Every employee, on or before the date of commencement of employment, shall furnish his or her employer with a signed Alabama with- holding exemption certificate relating to the number of withholding exemptions which he or she claims, which in no event shall exceed the number to which the employee is entitled. In the event the employee inflates the number of exemptions allowed by this Chapter on Form A4, the employee shall pay a penalty of five hundred dollars ($500) for such action pursuant to Section 40-29-75.

Part I – To be completed by the employee
EMPLOYEE NAME*
EMPLOYEE SOCIAL SECURITY NUMBER*
STREET ADDRESS*
CITY*
STATE*
ZIP CODE*
HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS
1. If you claim no personal exemption for yourself and wish to withhold at the highest rate, write the figure "0".*
SIgn and date Form and file it with your employer
Write the letter “S” if claiming the SINGLE exemption or “MS” if claiming the MARRIED FILING SEPARATELY exemption*
3. If you are MARRIED or SINGLE CLAIMING HEAD OF FAMILY, a $3,000 personal exemption is allowed.
Write the letter “M” if you are claiming an exemption for both yourself and your spouse or “H” if you are single with qualifying dependents and are claiming the HEAD OF FAMILY exemption
4. Number of dependents (other than spouse) that you will provide more than one-half of the support for during the year. See dependent qualification below.
DEPENDENTS: To qualify as your dependent (Line 4 above), a person must receive more than one-half of his or her support from you for the year and must be related to you as follows: Your son or daughter (including legally adopted children), 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
5. Additional amount, if any you want deducted each pay period
Employee’s Signature
Signature

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Employers are required to keep this certificate on file. If the employee is believed to have claimed more exemption than legally entitled or claims 8 or more dependent exemptions, the employer should contact the Department at the following address or phone number for ver- ification: Alabama Department of Revenue, Withholding Tax Section, P.O. Box 327480, Montgomery, AL 36132-7480, by phone at (334) 242-1300, or by fax at (334) 242-0112. If the employee does not qualify for the exemptions claimed upon verification, the employer is re- quired to withhold at the highest rate until the employee submits a corrected Form A4 reflecting the proper exemption they are entitled to claim.
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Alabama State Form A4

ALABAMA DEPARTMENT OF REVENUE

Employee’s Withholding Tax Exemption Certificate

HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS

Employee’s Signature