W-4 Form

Personal Allowances Worksheet

A Enter 1 if no one else can claim you as a dependent A _________
B  Enter 1 if:
  • You are single and have only one job; or
  • 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 $1,000 or less.
 B _________
C  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 to little tax withheld) C __________
D Enter number of dependents you will claim on your tax return. D ___________
E Enter 1 if you will file as head of household on your tax return E ___________
F Enter 1 if you have at least $1,500 of child or dependent care expenses for which you plan to claim a credit F ___________
G Add lines A through F and enter total here G ___________

Employee's Withholding Allowance Certificate

First Name:
Last Name:
Social Security Number:
Address:
Single   Married   Married, but withhold at higher Single rate.
City, State and ZIP code:  
5 Total number of allowances you are claiming. ___________
6 Additional amount, if any, you want withheld from each paycheck. ___________
Employee's signature Date:
Employer's name and address