Last year, did you have a right to a refund of ALL Federal income tax withheldD
This year, do you expect a refund of ALL Federal income tax withheld
Year Exempt from Withholding
Full-time student
Employer's name and address
Employer identification number
Adjusted allowances
Personal adjusted allowances
Two job allowances
Combined earnings
Lowest paying job
Highest paying job
Are you married?
Do you have more than one job?&
Enter your wages from your primary job)
Enter your number of pay periods per year%
Enter your wages from your second job
Do you plan to itemize*
Do you plan to claim adjustments to income)
Are you and your spouse legally separated"
Is your spouse a nonresident alien
Does your spouse work?
Spouses wages
Spouse plus second job wages)
Can you be claimed as another's dependent
Do you have nonwage income
Is your total income over $500+
Enter your child or dependent care expenses
Personal allowance
Special allowance
Spouse allowance
Dependent allowances
Head of household allowance
Child care allowance
Total personal allowances
Estimated itemized deductions
Standard deduction
Allowed deduction
Estimated adjustments to income
Deduction plus adjustments
Estimated nonwage income
Total adjustments
Adjustment allowances
Total adjusted allowances
Table 1 value
Two earner allowance
Table 1 value (from above))
Personal adjusted allowances (from above)
Two earner penalty
Table 2 value
Additional annual amount
Additional per period
Adjusted personal allowances
Two job penalty
Date >
Office code
Are you filing jointly?
Are you a qualifying widow(er)?6
Do you want to consider filing as head of a household?3
Can you claim your father or mother as a dependent?T
Did you pay more than half the cost of the principal home for your dependent parent?N
Did you pay more than half the cost of keeping up the home in which you lived?
Did a child or other close relative live with you for more than 6 months of the year? (See Instructions for Form 1040 for more details)
Head of household
Other than parent in their home
Exempt from Withholding@
Enter the year for which exemption from withholding is effective(
Does your spouse have more than one job?%
Enter wages from spouse's primary job)
Enter wages from your spouse's second job
Courier
OMB No. 1545-0010
W-4
Employee's Withholding Allowance Certificate,
For Privacy Act and Paperwork Reduction Act Notice, see instructions.(
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If married, but legally separated, or spouse is a nonresident alien, check the Single box
Note:
Total number of allowances you are claiming (from appropriate worksheets) . . . . . . . . . . . . . . . . . .
Additional amount, if any, you want deducted from each pay . . . . . . . . . . . . . . . . . . . . . . . .
I claim exemption from withholding and I certify that I meet ALL of the following conditions for exemption:
- Last year I had a right to a refund of ALL Federal income tax withheld because I had NO tax liability;
- This year I expect a refund of ALL Federal income tax withheld because I expect to have NO tax liability;
- If my income exceeds $500 including nonwage income, another person cannot claim me as a dependent.
If you meet all of the above conditions, enter the year effective and "EXEMPT" here . . . . . . . . . .
Are you a full-time student (Note: Full-time students are not automatically exempt.) . . . . . . . . . . . . . .
Under penalties of perjury, I certify that I am entitled to the number of claimed allowances or entitled to claim exempt status.
Employee's Signature >
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Personal Allowances Worksheet
Enter "1" for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . . . . . . .
You are single and have only one job; or<
Enter "1" if:
You are married, have only one job, and your spouse does not work; or<
Your wages from a second job or your spouse's wages (or the total of both) are $2,500 or less.<
Enter "1" for your spouse. But, you may choose to enter "0" if you are married and have either a working spouse or more than one job (this may help you avoid having too little tax withheld) . . . . . . . . . . . . . . . . . . . . .
Enter number of dependents (other than your spouse and yourself) whom you will claim on your tax return . . .
Enter "1" if you will file as a head of household on your tax return . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter "1" if you have at least $1,500 of child or dependent care expenses which you plan to claim . . . . . . . . .
Add lines A through F and enter total here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
- If you plan to itemize or claim adjustments to income and want to reduce your withholding, complete the Deductions and Adjustments Worksheet.H
For accuracy, do all worksheets that apply.
- If you are single and have more than one job and your combined earnings from all jobs exceed $25,000, then complete the Two-Earner/Two-Job Worksheet to avoid having too little tax withheld.H
- If you are married and have a working spouse or more than one job, and the combined earnings from all jobs exceed $44,000, then complete the Two-Earner/Two-Job Worksheet to avoid having too little tax withheld.H
- If none of the above situations applies to you, enter the number from line G on line 4 of form W-4.H
Deductions and Adjustments Worksheet
Note:
Use this worksheet only if you plan to itemize deductions or claim adjustments to income on your 1990 tax return.
Enter an estimate of your 1990 itemized deductions. These include: qualifying home mortgage interest, 10% of personal interest, charitable contributions, state and local taxes (but not sales taxes), "excess" medical expenses, and "excess" deductions . . . . . . . . . . . . . . . . . . . . . .
$5,450 if married filing jointly or qualifying widow(er)(
Enter:
$4,750 if head of household(
$3,250 if single(
$2,725 if married filing separately(
Subtract line 2 from line 1. If line 2 is greater than line 1, enter zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter an estimate of your 1990 adjustments to income. These include alimony paid and deductible IRA contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter an estimate of your 1990 nonwage income (such as dividends or interest income) . . . . . . . . . . .
Subtract line 6 from line 5. Enter the result, but not less than zero . . . . . . . . . . . . . . . . . . . . . .
Divide the amount on line 7 by $2,000 and enter the result here. Drop any fraction . . . . . . . . . . .
Enter the number from Personal Allowances Worksheet, line G . . . . . . . . . . . . . . . . . . . . . .
Add lines 8 and 9 and enter the total here. If you do not need to use the Two-Earner/Two-Job Worksheet, enter this total on Form W-4 line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Two-Earner/Two-Job Worksheet
Note:
Use this worksheet only if instructions at line G on Personal Allowances Worksheet direct you to.
Enter the number from line G of Personal Allowances Worksheet or from line 10 of the Deductions and Adjustments Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the number from Table 1 that applies to the lowest paying job . . . . . . . . . . . . . . . . . . . . . .
If line 1 is greater than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter "0") and on form W-4 line 4. Do not use the rest of this worksheet . . . . . . . . . . . . . . . . . . . . . .
Note:
If line 1 is less than line 2, enter "0" on Form W-4 line 4. Complete lines 4-9 to calculate the additional dollar withholding necessary to avoid a year-end tax bill.
Enter the number from line 2 of this worksheet . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the number from line 1 of this worksheet . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the number from Table 2 that applies to the highest paying job . . . . . . . . . . . . . . . .
Multiply line 7 by line 6 and enter the result here. . . . . . . . . . . . . . . . . . . . . . .
Divide line 8 by the number of pay periods each year. (For example, divide by 26 if you are paid every other week.) Enter the result here and on Form W-4 line 5. . . . . . . . . . . . . . . . . . . . . . . .
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