I. Employee agrees during employment and thereafter for the longest time permitted by applicable law not to disclose or use any COHFS confidential information, except in carrying out the duties of Employee's employment with COHFS, or as expressly requested by COHFS. Confidential information includes but is not limited to information regarding the methods and procedures used by COHFS, curriculum and training materials, program processes, intake procedures, personnel information, business plans, referral lists, financial and marketing information, proprietary information, all information known only to those persons in a confidential relationship with COHFS, any materials, documents or information in whatever form containing or reflecting any COHFS confidential or proprietary information and all information designated by COHFS as confidential or proprietary. Except as Employee's duties require, Employee agrees not to produce or permit, directly or indirectly, the production or reproduction of any document or other form of communication containing or constituting confidential or proprietary information. Upon termination or request by COHFS, Employee shall return to COHFS all confidential and proprietary information and all copies of such information, and all other property of COHFS in Employee's possession or control.

II. The parties acknowledge that this Section is fair and reasonable under the circumstances. It is the desire and intent of the parties that the provisions of this Section shall be enforced to the fullest extent permitted by law. COHFS is entitled to, and Employee agrees not to oppose COHFS's request for, equitable relief in the form of specific performance, a temporary restraining order, a temporary or permanent injunction or other equitable remedy, without any requirement that COHFS post bond. If contrary to this provision a court shall require COHFS to post bond in connection with the entry of an injunctive order, the parties agree that such bond shall be without surety, and may stand as COHFS's own undertaking. Accordingly, if any particular portion of this Section shall be adjudicated to be invalid or unenforceable, this Section shall be deemed amended to (i) reform the particular portion to provide for such maximum restrictions as will be valid and enforceable or, if that is not possible, (ii) delete the portion adjudicated to be invalid or unenforceable, such reformation or deletion to apply only with respect to the operation of this Section in the particular jurisdiction in which the adjudication is made. The parties agree that injunctive relief shall not be the sole and exclusive remedy of COHFS, nor shall an initiation of any action requesting same constitute an election of remedies, but COHFS is also entitled to seek damages to the fullest extent authorized by law in the event of a breach.

III. Employee acknowledges that during the course of employment, Employee will acquire confidential information about the curriculum, programs, procedures, documentation, business and methods of COHFS, its clients and prospective clients and other information and systems utilized by COHFS, and that such confidential information has great value and would provide an unfair advantage in competing with COHFS. Based upon the foregoing, Employee acknowledges that the covenants contained in this Section (i) are necessary for the protection of COHFS, (ii) do not impose undue hardship on Employee or prevent Employee from becoming gainfully employed and (iii) are not injurious to the public.

1

IV. Employee acknowledges and agrees that these covenants are the essence of this Agreement and shall be construed as independent of any other provision of this Agreement, and the existence of any claim or cause of action of Employee against COHFS, whether predicated on this Agreement or otherwise, shall not constitute a defense to the enforcement by COHFS of any of these covenants. Employee acknowledges and agrees that if Employee breaches any of these covenants, COHFS will suffer irreparable harm and will have no adequate remedy at law.

V. If it is judicially determined that Employee has violated any obligations under this Agreement, then the period applicable to each obligation determined to have been violated shall automatically be extended by a period of time equal in length to the period during which such violation(s) occurred, including the period of time as may be required through litigation (including appeals) or otherwise to obtain strict compliance with the terms of this Agreement. The restrictive period shall also be extended by a period of time equal in length to any period during which COHFS is not operating pursuant to a local, state or national directive.

VI. Employee acknowledges and agrees that, as additional consideration for entering into the covenants set forth in this Section, Employee is granted compensation and benefits in accordance with Employee's employment. Employee agrees that Employee's employment is specifically conditioned upon Employee entering into these covenants. No other promise or inducement, other than specifically included in this Agreement, has been given for entering into these covenants. These covenants shall survive the termination of this Agreement and the termination of Employee's employment.

We provide unique services while promoting self-sufficiency and we take pride in our care. During your work with CHFS, you may receive information of a non-public nature for your use in connection with your work. CHFS considers all non-public information to be proprietary and confidential unless it is otherwise described in writing. This information includes operational plans; technical and financial information; business information, models, methods, and plans; client, donor, partner, and prospect lists; service concepts and documents; reports; strategic plans; templates; mailing lists; proposed business transactions with third parties; market projects; and all trade secrets or other non-public information from or about CHFS. Proprietary and confidential information includes information in any format whether intended for receipt by staff members or received inadvertently. If a staff member is not the intended recipient of such CHFS information, the staff member should not review, read, copy, store, or use the information, or disclose it to others. The staff member should report the receipt to the CEO immediately.

CHFS respects the privacy of others. In the course of its activities, CHFS collects, uses, and maintains personal and confidential information about clients, partners, staff, and other individuals related to CHFS's business. At no time should confidential information be knowingly shared or disseminated to unauthorized parties. Personal and confidential information includes any information or communications in any format whether intended for receipt by staff members or received inadvertently. If a staff member receives such information inadvertently, the staff member should not review, read, copy, store, or use the information, or disclose it to others. The staff member should report the receipt to the CEO immediately.

Staff members who have access to confidential information must use and/or disclose that information only as appropriate for the performance of their jobs. Particular care must be taken to keep confidential any information regarding clients, partners, and staff, or information received under an express or implied secrecy obligation for information received from third parties, whether received inadvertently or not.

Information acquired in the course of employment must not be used for individual benefit. Access to confidential information imposes an obligation to keep such information confidential and to use it solely in the interest of CHFS. When in doubt, the staff member should treat the matter in the strictest confidence and consult the CEO for clarification.

Employees must realize that CHFS's information is just for CHFS's use and not for distribution to the public or third parties. Any external requests for information or public distribution should be directed to the CEO for prior approval before any information or response is provided.

All records, papers, and documents kept or made relating to the business of CHFS, CHFS's affiliates, or CHFS's clients will remain the property of CHFS and must be returned to CHFS immediately upon termination of employment. Using proprietary or confidential information from prior employment is also prohibited.

No information about any client's account may be given to anyone other than the client or the client's legal representative. Any person requesting this information must be able to offer necessary identification. Violating this policy or disclosing confidential information improperly may result in discipline up to and including the immediate dismissal of the employee involved. Refer the matter to the supervisor in charge whenever there is any doubt about the authority of the individual requesting information or the propriety of releasing the information.

There is also support for this in the Computers, E-Mail, Voice Mail, and Communication Systems policy, as follows:

Computers, laptops, iPads, networks, software, apps, platforms, copy machines, telephones, mobile devices, pagers, voice mail, and e-mail systems are the property of CHFS. These tools and access to the Internet are intended to be used only for business purposes of CHFS and not for personal purposes of the employees or for inappropriate uses. Employees should have no expectation of privacy in using CHFS equipment, systems, or property. All documents or messages created, sent, received, stored, or downloaded by employees are subject to monitoring to determine whether any outsiders have gained unauthorized access to the systems or whether any violations of CHFS policy have occurred. If a staff member receives information outside the scope of their explicit job responsibilities, in any format, it should be reported to the CEO immediately. The staff member should not review, read, copy, store, or use the information, or disclose it to others. No staff member is permitted to install or utilize any app or software that enables them to view unauthorized information or communication. Passwords, encryption or other techniques that prevent CHFS from accessing information are prohibited.

SP103102

Fax to 847-676-5136 For questions, please call 877-954-7873

Form W-4

OMB No. 1545-0074

Department of the Treasury
Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
Give Form W-4 to your employer.
Your withholding is subject to review by the IRS.

2025

Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

TIP: Consider using the estimator at www.irs.gov/W4App to determine the most accurate withholding for the rest of the year if: you are completing this form after the beginning of the year; expect to work only part of the year; or have changes during the year in your marital status, number of jobs for you (and/or your spouse if married filing jointly), dependents, other income (not from jobs), deductions, or credits. Have your most recent pay stub(s) from this year available when using the estimator. At the beginning of next year, use the estimator again to recheck your withholding.

Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App.

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following.
(a) Use the estimator at www.irs.gov/W4App for the most accurate withholding for this step (and Steps 3-4). If you or your spouse have self-employment income, use this option; or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or
(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job.)

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employers Only

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Cat. No. 10220Q

Form W-4 (2025)

Form W-4 (2025)

Page 2

amount to have withheld.

Section references are to the Internal Revenue Code unless otherwise noted.

For the latest information about developments related to Form W-4, such as legislation enacted after it was published, go to www.irs.gov/FormW4.

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. If too little is withheld, you will generally owe tax when you file your tax return and may owe a penalty. If too much is withheld, you will generally be due a refund. Complete a new Form W-4 when changes to your personal or financial situation would change the entries on the form. For more information on withholding and when you must furnish a new Form W-4, see Pub. 505, Tax Withholding and Estimated Tax.

Exemption from withholding. You may claim exemption from withholding for 2025 if you meet both of the following conditions: you had no federal income tax liability in 2024 and you expect to have no federal income tax liability in 2025. You had no federal income tax liability in 2024 if (1) your total tax on line 24 on your 2024 Form 1040 or 1040-SR is zero (or less than the sum of lines 27, 28, and 29), or (2) you were not required to file a return because your income was below the filing threshold for your correct filing status. If you claim exemption, you will have no income tax withheld from your paycheck and may owe taxes and penalties when you file your 2025 tax return. To claim exemption from withholding, certify that you meet both of the conditions above by writing "Exempt" on Form W-4 in the space below Step 4(c). Then, complete Steps 1(a), 1(b), and 5. Do not complete any other steps. You will need to submit a new Form W-4 by February 17, 2026.

Your privacy. Steps 2(c) and 4(a) ask for information regarding income you received from sources other than the job associated with this Form W-4. If you have concerns with providing the information asked for in Step 2(c), you may choose Step 2(b) as an alternative; if you have concerns with providing the information asked for in Step 4(a), you may enter an additional amount you want withheld per pay period in Step 4(c) as an alternative.

When to use the estimator. Consider using the estimator at www.irs.gov/W4App if you:

1. Are submitting this form after the beginning of the year;
2. Expect to work only part of the year;
3. Have changes during the year in your marital status, number of jobs for you (and/or your spouse if married filing jointly), or number of dependents, or changes in your deductions or credits;
4. Receive dividends, capital gains, social security, bonuses, or business income, or are subject to the Additional Medicare Tax or Net Investment Income Tax; or
5. Prefer the most accurate withholding for multiple job situations.

TIP: Have your most recent pay stub(s) from this year available when using the estimator to account for federal income tax that has already been withheld this year. At the beginning of next year, use the estimator again to recheck your withholding.

Self-employment. Generally, you will owe both income and self-employment taxes on any self-employment income you receive separate from the wages you receive as an employee. If you want to pay these taxes through withholding from your wages, use the estimator at www.irs.gov/W4App to figure the

Nonresident alien. If you're a nonresident alien, see
Notice 1392, Supplemental Form W-4 Instructions for
Nonresident Aliens, before completing this form.

owe.

Step 1(c). Check your anticipated filing status. This will
determine the standard deduction and tax rates used to
compute your withholding.

Step 2. Use this step if you (1) have more than one job at
the same time, or (2) are married filing jointly and you and
your spouse both work. Submit a separate Form W-4 for
each job.

Option (a) most accurately calculates the additional tax
you need to have withheld, while option (b) does so with a
little less accuracy.

Instead, if you (and your spouse) have a total of only two
jobs, you may check the box in option (c). The box must
also be checked on the Form W-4 for the other job. If the
box is checked, the standard deduction and tax brackets
will be cut in half for each job to calculate withholding. This
option is accurate for jobs with similar pay; otherwise, more
tax than necessary may be withheld, and this extra amount
will be larger the greater the difference in pay is between the
two jobs.

Multiple jobs. Complete Steps 3 through 4(b) on
only one Form W-4. Withholding will be most
accurate if you do this on the Form W-4 for the
highest paying job.

Step 3. This step provides instructions for determining the
amount of the child tax credit and the credit for other
dependents that you may be able to claim when you file
your tax return. To qualify for the child tax credit, the child
must be under age 17 as of December 31, must be your
dependent who generally lives with you for more than half
the year, and must have the required social security number.
You may be able to claim a credit for other dependents for
whom a child tax credit can't be claimed, such as an older
child or a qualifying relative. For additional eligibility
requirements for these credits, see Pub. 501, Dependents,
Standard Deduction, and Filing Information. You can also
include other tax credits for which you are eligible in this
step, such as the foreign tax credit and the education tax
credits. To do so, add an estimate of the amount for the year
to your credits for dependents and enter the total amount in
Step
3. Including these credits will increase your paycheck and
reduce the amount of any refund you may receive when you
file your tax return.

Step 4(a). Enter in this step the total of your other
estimated income for the year, if any. You shouldn't include
income from any jobs or self-employment. If you complete
Step 4(a), you likely won't have to make estimated tax
payments for that income. If you prefer to pay estimated tax
rather than having tax on other income withheld from your
paycheck, see Form
1040-ES, Estimated Tax for Individuals.

Step 4(b). Enter in this step the amount from the
Deductions Worksheet, line 5, if you expect to claim
deductions other than the basic standard deduction on your
2025 tax return and want to reduce your withholding to
account for these deductions.
This includes both itemized deductions and other
deductions such as for student loan interest and IRAs.

Step 4(c). Enter in this step any additional tax you want
withheld from your pay each pay period, including any
amounts from the Multiple Jobs Worksheet, line 4. Entering
an amount here will reduce your paycheck and will either
increase your refund or reduce any amount of tax that you

Form W-4 (2025)

Page 3

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job. To be accurate, submit a new Form W-4 for all other jobs if you have not updated your withholding since 2019.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables; or, you can use the online withholding estimator at www.irs.gov/W4App.

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person with no other entries on the form; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and territories for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

Form W-4 (2025)

Page 4

Married Filing Jointly or Qualifying Surviving Spouse

	$0 9,999	$10,000 19,999	$20,000 29,999	$30,000 39,999	$40,000 - 49,999	$50,000 - 59,999	$60,000 - 69,999	$70,000 - 79,999	$80,000 - 89,999	$90,000 99,999	$100,000 109,999	$110,000 - 120,000
$0 9,999	$0	$0	$700	$850	$910	$1,020	$1,020	$1,020	$1,020	$1,020	$1,020	$1,020
$10,000 19,999	0	700	1,700	1,910	2,110	2,220	2,220	2,220	2,220	2,220	2,220	3,220
$20,000 29,999	700	1,700	2,760	3,110	3,310	3,420	3,420	3,420	3,420	3,420	4,420	5,420
$30,000 39,999	850	1,910	3,110	3,460	3,660	3,770	3,770	3,770	3,770	4,770	5,770	6,770
$40,000 49,999	910	2,110	3,310	3,660	3,860	3,970	3,970	3,970	4,970	5,970	6,970	7,970
$50,000 59,999	1,020	2,220	3,420	3,770	3,970	4,080	4,080	5,080	6,080	7,080	8,080	9,080
$60,000 69,999	1,020	2,220	3,420	3,770	3,970	4,080	5,080	6,080	7,080	8,080	9,080	10,080
$70,000 79,999	1,020	2,220	3,420	3,770	3,970	5,080	6,080	7,080	8,080	9,080	10,080	11,080
$80,000 99,999	1,020	2,220	3,420	4,620	5,820	6,930	7,930	8,930	9,930	10,930	11,930	12,930
$100,000 149,999	1,870	4,070	6,270	7,620	8,820	9,930	10,930	11,930	12,930	14,010	15,210	16,410
$150,000 239,999	1,870	4,240	6,640	8,190	9,590	10,890	12,090	13,290	14,490	15,690	16,890	18,090
$240,000 259,999	2,040	4,440	6,840	8,390	9,790	11,100	12,300	13,500	14,700	15,900	17,100	18,300
$260,000 279,999	2,040	4,440	6,840	8,390	9,790	11,100	12,300	13,500	14,700	15,900	17,100	18,300
$280,000 299,999	2,040	4,440	6,840	8,390	9,790	11,100	12,300	13,500	14,700	15,900	17,100	18,300
$300,000 319,999	2,040	4,440	6,840	8,390	9,790	11,100	12,300	13,500	14,700	15,900	17,170	19,170
$320,000 364,999	2,040	4,440	6,840	8,390	9,790	11,100	12,470	14,470	16,470	18,470	20,470	22,470
$365,000 524,999	2,790	6,290	9,790	12,440	14,940	17,350	19,650	21,950	24,250	26,550	28,850	31,150
$525,000 and over	3,140	6,840	10,540	13,390	16,090	18,700	21,200	23,700	26,200	28,700	31,200	33,700

Single or Married Filing Separately

	$0 9,999	$10,000 19,999	$20,000 29,999	$30,000 39,999	$40,000 49,999	$50,000 59,999	$60,000 69,999	$70,000 79,999	$80,000 89,999	$90,000 99,999	$100,000 - 109,999	$110,000 120,000
$0 9,999	$200	$850	$1,020	$1,020	$1,020	$1,370	$1,870	$1,870	$1,870	$1,870	$1,870	$2,040
$10,000 19,999	850	1,700	1,870	1,870	2,220	3,220	3,720	3,720	3,720	3,720	3,890	4,090
$20,000 29,999	1,020	1,870	2,040	2,390	3,390	4,390	4,890	4,890	4,890	5,060	5,260	5,460
$30,000 39,999	1,020	1,870	2,390	3,390	4,390	5,390	5,890	5,890	6,060	6,260	6,460	6,660
$40,000 59,999	1,220	3,070	4,240	5,240	6,240	7,240	7,880	8,080	8,280	8,480	8,680	8,880
$60,000 79,999	1,870	3,720	4,890	5,890	7,030	8,230	8,930	9,130	9,330	9,530	9,730	9,930
$80,000 99,999	1,870	3,720	5,030	6,230	7,430	8,630	9,330	9,530	9,730	9,930	10,130	10,580
$100,000 124,999	2,040	4,090	5,460	6,660	7,860	9,060	9,760	9,960	10,160	10,950	11,950	12,950
$125,000 149,999	2,040	4,090	5,460	6,660	7,860	9,060	9,950	10,950	11,950	12,950	13,950	14,950
$150,000 174,999	2,040	4,090	5,460	6,660	8,450	10,450	11,950	12,950	13,950	15,080	16,380	17,680
$175,000 199,999	2,040	4,290	6,450	8,450	10,450	12,450	13,950	15,230	16,530	17,830	19,130	20,430
$200,000 249,999	2,720	5,570	7,900	10,200	12,500	14,800	16,600	17,900	19,200	20,500	21,800	23,100
$250,000 399,999	2,970	6,120	8,590	10,890	13,190	15,490	17,290	18,590	19,890	21,190	22,490	23,790
$400,000 449,999	2,970	6,120	8,590	10,890	13,190	15,490	17,290	18,590	19,890	21,190	22,490	23,790
$450,000 and over	3,140	6,490	9,160	11,660	14,160	16,660	18,660	20,160	21,660	23,160	24,660	26,160

Head of Household

	$0 9,999	$10,000 19,999	$20,000 - 29,999	$30,000 - 39,999	$40,000 49,999	$50,000 - 59,999	$60,000 69,999	$70,000 - 79,999	$80,000 89,999	$90,000 99,999	$100,000 - 109,999	$110,000 - 120,000
$0 9,999	$0	$450	$850	$1,000	$1,020	$1,020	$1,020	$1,020	$1,870	$1,870	$1,870	$1,890
$10,000 19,999	450	1,450	2,000	2,200	2,220	2,220	2,220	3,180	4,070	4,070	4,090	4,290
$20,000 29,999	850	2,000	2,600	2,800	2,820	2,820	3,780	4,780	5,670	5,690	5,890	6,090
$30,000 39,999	1,000	2,200	2,800	3,000	3,020	3,980	4,980	5,980	6,890	7,090	7,290	7,490
$40,000 59,999	1,020	2,220	2,820	3,830	4,850	5,850	6,850	8,050	9,130	9,330	9,530	9,730
$60,000 79,999	1,020	3,030	4,630	5,830	6,850	8,050	9,250	10,450	11,530	11,730	11,930	12,130
$80,000 99,999	1,870	4,070	5,670	7,060	8,280	9,480	10,680	11,880	12,970	13,170	13,370	13,570
$100,000 124,999	1,950	4,350	6,150	7,550	8,770	9,970	11,170	12,370	13,450	13,650	14,650	15,650
$125,000 149,999	2,040	4,440	6,240	7,640	8,860	10,060	11,260	12,860	14,740	15,740	16,740	17,740
$150,000 174,999	2,040	4,440	6,240	7,640	8,860	10,860	12,860	14,860	16,740	17,740	18,940	20,240
$175,000 199,999	2,040	4,440	6,640	8,840	10,860	12,860	14,860	16,910	19,090	20,390	21,690	22,990
$200,000 249,999	2,720	5,920	8,520	10,960	13,280	15,580	17,880	20,180	22,360	23,660	24,960	26,260
$250,000 449,999	2,970	6,470	9,370	11,870	14,190	16,490	18,790	21,090	23,280	24,580	25,880	27,180
$450,000 and over	3,140	6,840	9,940	12,640	15,160	17,660	20,160	22,660	25,050	26,550	28,050	29,550

Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
OMB No.1615-0047
Expires 05/31/2027

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.
ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form 1-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.

I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3.

Lauthorized by the Secretary of DHS. documentation from List AbRla combination of documentation from List Band List C. Enter any additional

Certification: I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to the best of my knowledge, the employee is authorized to work in the United States.

For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.

Form 1-9 Edition 01/20/25

Page 1 of 4

All documents containing an expiration date must be unexpired.
* Documents extended by the issuing authority are considered unexpired.
Employees may present one selection from List A or a
combination of one selection from List B and one selection from List C.
Examples of many of these documents appear in the Handbook for Employers (M-274).

May be presented in lieu of a document listed above for a temporary period.
For receipt validity dates, see the M-274.

Receipt for a replacement of a lost, stolen, or damaged List A document. Form I-94 issued to a lawful permanent resident that contains an I-551 stamp and a photograph of the individual. Form I-94 with "RE" notation or refugee stamp issued to a refugee.

OR

Receipt for a replacement of a lost, stolen, or damaged List B document.

Receipt for a replacement of a lost, stolen, or damaged List C document.

*Refer to the Employment Authorization Extensions page on I-9 Central for more information.

Form 1-9 Edition 01/20/25

Page 2 of 4

Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
Supplement A
OMB No. 1615-0047
Expires 05/31/2027

Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translator must complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee's completed Form I-9.

Form 1-9 Edition 01/20/25

Page 3 of 4

Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
Supplement B
OMB No. 1615-0047
Expires 05/31/2027

Instructions: This supplement replaces Section 3 on the previous version of Form 1-9. Only use this page if your employee requires reverification, is rehired within three years of the date the original Form 1-9 was completed, or provides proof of a legal name change. Enter the employee's name in the fields above. Use a new section for each reverification or rehire. Review the Form 1-9 instructions before completing this page. Keep this page as part of the employee's Form 1-9 record. Additional guidance can be found in the Handbook for Employers: Guidance for Completing Form 1-9 (M-274)

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Form 1-9 Edition 01/20/25

Page 4 of 4

As of 12/7/20 this new version of the IT 4 combines and replaces the following forms: II 4 (previous version), IT 4NR, IT 4 MIL, and IT MIL SP.

IT 4
Rev. 01/24

Submit form IT 4 to your employer on or before the start date of employment so your employer will withhold and remit Ohio income tax from your compensation. If applicable, your employer will also withhold school district income tax. You must file an updated IT 4 when any of the information listed below changes (including your marital status or number of dependents). You should contact your employer for instructions on how to complete an updated IT 4. Your employer may require you to complete this form electronically.

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the information is true, correct and complete.

As of 12/7/20 this new version of the IT 4 combines and replaces the following forms: IT 4 (previous version), IT 4NR, IT 4 MIL, and IT MIL SP.

Most individuals are subject to Ohio income tax on their wages, salaries, or other compensation. To ensure this tax is paid, employers maintaining an office or transacting business in Ohio must withhold Ohio income tax, and school district income tax if applicable, from each individual who is an employee.

income tax. This amount should be reported in whole dollars.

Such employees who are subject to Ohio income tax (and school district income tax, if applicable) should complete sections I, II, and IV of the IT 4 to have their employer withhold the appropriate Ohio taxes from their compensation. If the employee does not complete the IT 4 and return it to his/her employer, the employer:

• Will withhold Ohio tax based on the employee claiming zero exemptions, and
• Will not withhold school district income tax, even if the employee lives in a taxing school district.

An individual may be subject to an interest penalty for underpayment of estimated taxes (on form IT/SD 2210) based on under-withholding.

Certain employees may be exempt from Ohio withholding because their income is not subject to Ohio tax. Such employees should complete sections I, III, and IV of the IT 4 only.

The IT 4 does not need to be filed with the Department of Taxation. Your employer must maintain a copy as part of its records.

R.C. 5747.06(A) and Ohio Adm.Code 5703-7-10.

Enter the four-digit school district number of your primary address. If you do not know your school district of residence or its school district number, use The Finder at tax.ohio.gov. You can also verify your school district by contacting your county auditor or county board of elections.

If you move during the tax year, complete an updated IT 4 immediately reflecting your new address and/ or school district of residence.

Line 1: If you can be claimed on someone else's Ohio income tax return as a dependent, then you are to enter "0" on this line. Everyone else may enter "1".

Line 2: If you are single, enter "0" on this line. If you are married and you and your spouse file separate Ohio Income tax returns as "Married filing Separately" then enter "0" on this line.

Line 3: You are allowed one exemption for each dependent. Your dependents for Ohio income tax purposes are the same as your dependents for federal income tax purposes. See R.C. 5747.01 (Ο).

Line 5: If you expect to owe more Ohio income tax than the amount withheld from your compensation, you can request that your employer withhold an additional amount of Ohio

Note: If you do not request additional withholding from your compensation, you may need to make estimated income tax payments using form IT 1040ES or estimated school district income tax payments using the SD 100ES. Individuals who commonly owe more in Ohio income taxes than what is withheld from their compensation include:

• Spouses who file a joint Ohio income tax return and both report income, and
• Individuals who have multiple jobs, all of which are subject to Ohio withholding.

This section is for individuals whose income is deductible or excludable from Ohio income tax, and thus employer withholding is not required. Such employee should check the appropriate box to indicate which exemption applies to him/her. Checking the box will cause your employer to not withhold Ohio income tax and/or school district income tax. The exemptions include:

• Reciprocity Exemption: If you are a resident of Indiana, Kentucky, Pennsylvania, Michigan or West Virginia and you work in Ohio, you do not owe Ohio income tax on your compensation. Instead, you should have your employer withhold income tax for your resident state. R.C. 5747.05(A)(2).
• Resident Military Servicemember Exemption: If you are an Ohio resident and a member of the United States Army, Air Force, Navy, Marine Corps, or Coast Guard (or the reserve components of these branches of the military) or a member of the National Guard, you do not owe Ohio income tax or school district income tax on your active duty military pay and allowances received while stationed outside of Ohio.

This exemption does not apply to compensation for nonactive duty status or received while you are stationed in Ohio. R.C. 5747.01(A)(21).

• Nonresident Military Servicemember Exemption: If you are a nonresident of Ohio and a member of the uniformed services (as defined in 10 U.S.C. §101), you do not owe Ohio income tax or school district income tax on your military pay and allowances.
• Nonresident Civilian Spouse of a Military Servicemember Exemption: If you are the civilian spouse of a military servicemember, your pay may be exempt from Ohio income tax and school district income tax if all of the following are true:

• Your spouse is stationed in Ohio on military orders; and
• You are present in Ohio solely to be with your spouse.

You must provide a copy of the employee's spousal military identification card issued to the employee by the Department of Defense when completing the IT 4.

As of 12/7/20 this new version of the IT 4 combines and replaces the following forms: IT 4 (previous version), IT 4NR, IT 4 MIL, and IT MIL SP.

Note: For more information on taxation of military servicemembers and their civilian spouses, see 50 U.S.C.A. 4001 and tax.ohio.gov/military.

• Statutory Withholding Exemptions: Compensation earned in any of the following circumstances is not subject to Ohio income tax or school district income tax withholding:
• Agricultural labor (as defined in 26 U.S.C. §3121(g));
• Domestic service in a private home, local college club, or local chapter of a college fraternity or sorority;
• Services performed by an employee who is regularly employed by an employer to perform such service if she or he earns less than $300 during a calendar quarter;

• Newspaper or shopping news delivery or distribution directly to a consumer, performed by an individual under the age of 18;
• Services performed for a foreign government or an international organization; and
• Services performed outside the employer's trade or business if paid in any medium other than cash.

*These exemptions are not common.

Note: While the employer is not required to withhold on these amounts, the income is still subject to Ohio income tax and school district income tax (if applicable). As such, you may need to make estimated income tax payments using form IT 1040ES and/or estimated school district income tax payments using form SD 100ES.

See R.C. 5747.06(A)(1) through (6).