2010
Form WT-4A
WORKSHEET FOR EMPLOYEE WITHHOLDING AGREEMENT
Married, expect to file a separate Wisconsin tax return
A.
Single
C.
1. Filing Status:
Married, expect to file a joint Wisconsin tax return
D.
Head of Household
Check one box
B.
2. Estimated 2010 Wisconsin income. (Caution: Before entering an amount, see the instructions for line 2 on the
2
reverse side. Include your income and your spouse's income if you checked filing status "B".)
3. Estimated standard deduction and exemptions. (See instructions for line 3 and Standard Deduction Schedules on the
3
reverse side. Use the schedule that corresponds with filing status checked. Part-year and nonresidents must prorate.)
4. Estimated taxable income. (Subtract line 3 from line 2.)
4
5. Estimated gross tax. (See Tax Rate Schedules on the reverse side. Use the schedule that corresponds with filing
5
status checked.)
6. Estimated credits. (See line 6 instructions on the reverse side.)
6
7. Estimated net tax liability for 2010. (Subtract line 6 from line 5. If the amount on line 6 exceeds the amount on
7
line 5, enter zero.)
8. Amount previously withheld and amount paid by Wisconsin Estimated Income Tax Voucher for 2010. (If you
8
checked filing status “B”, include amounts for both yourself and your spouse.)
9. Amount which will be withheld from spouse's wages during the balance of 2010. (Complete this line only if you
9
checked filing status “B”.)
1 0. Remaining amount to be withheld from your wages. (Add lines 8 and 9 and subtract the total from the amount
10
shown on line 7. Enter here and on line 1 of WT-4A agreement below.)
WISCONSIN
2010
WT-4A
EMPLOYEE WITHHOLDING AGREEMENT
Employee's Last Name
First Name and Initial
This agreement
April 30, 2011
(Calendar year filers)
(Fiscal year filers see instr.)
expires on:
Social Security Number
Employer's Name
Employee's Address (Number and Street)
Employer's Address (Number and Street)
City, State and Zip Code
City, State and Zip Code
EMPLOYEE – File a copy of
1. Remaining amount to be withheld. (From line 10 of employee withholding worksheet
1
this agreement and the above
above.)
worksheet with your employer and,
2. Remaining number of payroll periods for 2010. (Obtain this figure from your
within 10 days, send a copy to:
2
employer.)
Wis. Dept. of Revenue
PO Box 8906
3. Amount to be withheld each payroll period. (Divide line 1 by the number of payroll
Madison WI 53708-8906
3
periods entered on line 2.)
EMPLOYER – Retain this
I declare that to the best of my knowledge and belief the information contained in this agreement is true, correct and complete.
agreement in your files. The
amount on line 3 should be
withheld from the employee's
wages each payroll period rather
than the amount determined from
the Wis. Withholding Tax Guide.
(Signature of employee)
(Date)
INSTRUCTIONS
Form WT-4 (or federal Form W-4) with your employer and claiming an
Who may use this form for 2010
Form WT-4A may be filed by an employee who determines that the amount
increased number of exemptions. If you are claiming the maximum number
of exemptions allowed and your withholding is still more than your estimated
withheld from his or her wages will be more than the employee's estimated net
net tax liability for 2010, you should file Form WT-4A.
tax liability for 2010. Form WT-4A is an agreement between the employee and
employer that a lesser amount will be withheld from the employee's wages
Note: If you incurred no Wisconsin income tax liability for 2009 and anticipate
than is provided for in the Wisconsin income tax withholding tables.
no liability for 2010, you may claim complete exemption from Wisconsin
income tax withholding on Form WT-4.
Before filing Form WT-4A, you should first determine if your withholding
can be reduced a sufficient amount by claiming the maximum number of
exemptions allowed on Form WT-4, “Employee's Wisconsin Withholding
More than one employer
Exemption Certificate” (or on federal Form W-4, “Employee's Withholding
If you are employed by more than one employer, you may file an Employee
Allowance Certificate”) which you completed when you started employment
Withholding Agreement (Form WT-4A) with each employer, provided that
with your employer. If you are not claiming the maximum number of
the total amount withheld by all employers approximates your anticipated
exemptions allowed, you may decrease your withholding by filing a new
income tax liability for 2010.
W-234 (R. 11-09)