D-4 Dc Withholding Allowance Certificate
ADVERTISEMENT
1
2D-4 DC Withholding
Government of the
Enter Year
Allowance Certificate
District of Columbia
Social security number
FIrst name
Last name
M.I.
Home address (number and street)
City
State
Zip code +4
1
Tax filing status
Single
Married/domestic partners filing jointly
Married filing separately
Fill in only one:
Head of household
Married/domestic partners filing separately on same return
2
Total number of withholding allowances from worksheet below.
Enter total from Sec. A, Line i
Enter total from Sec. B, Line o
Total number of withholding allowances
3
Additional amount, if any, you want withheld from each paycheck
$
4
4
Before claiming exemption from withholding, read below. If qualified, write “EXEMPT” in this box.
5
My domicile is a state other than the District of Columbia
If yes, give name of state of domicile __________________
Yes
No
I am exempt because: last year I did not owe any DC income tax and had a right to a full refund of all DC income tax withheld from me; and this year I do
not expect to owe any DC income tax and expect a full refund of all DC income tax withheld from me; and I qualify for exempt status on federal Form W-4.
If claiming exemption from withholding, are you a full-time student?
Yes
No
Signature
Under penalties of law, I declare that the information provided on this certificate is, to the best of my knowledge, correct.
Employee’s signature
Date
Employer
Keep this certificate with your records. If 10 or more exemptions are claimed or if you suspect this certificate contains false information
please send a copy to: Office of Tax and Revenue, 1101 4th St., SW, Washington, DC 20024 Attn: Compliance Administration
Detach and give the top portion to your employer. Keep the bottom portion for your records.
D-4 DC Withholding Allowance Worksheet
Government of the
District of Columbia
Section A Number of withholding allowances
a Enter 1 for yourself
a
b Enter 1 if you are filing as a head of household
b
c
Enter 1 if you are 65 or over
c
d Enter 1 if you are blind
d
e Enter number of dependents
e
f
Enter 1 for your spouse/registered domestic partner if filing jointly
f
g Enter 1 if married/registered domestic partners filing jointly and your spouse/registered domestic partner is 65 or over
g
h Enter 1 if married/registered domestic partners filing jointly and your spouse/registered domestic partner is blind
h
i
Number of allowances . Add Lines a through h and enter on Line 2 above. If you want to claim additional withholding
i
allowances, complete section B below.
Section B Additional withholding allowances
j
Enter estimate of your itemized deductions
j
k Enter $2,000 if married/registered domestic partners filing separately; all others enter $4,000
k
l
Subtract Line k from Line j
l
m Multiply $1,675 by the number of allowances on Line i
m
n Divide Line l by Line m. Round to the nearest whole number.
n
o Add Lines n and i and enter on Line 2 above.
o
D-4 P1
Revised 12/2011
DC Withholding Allowance Certificate
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial