W4 And De 4 Form - San Diego Unified School District
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1Federal Employer ID Number:
95-6002781
San Diego Unified School District
4100 Normal Street
State Employer ID Number:
800-9336-2
San Diego, CA 92103
EMPLOYEE'S WITHHOLDING ALLOWANCE CERTIFICATE: FORM W-4 AND DE 4
SOCIAL SECURITY NUMBER
EMPLOYEE ID (IF YOU ARE A CURRENT EMPLOYEE)
NAME (LAST, FIRST, MIDDLE INITIAL)
IF YOU ARE A CURRENT EMPLOYEE, PLEASE PROVIDE THE FOLLOWING:
LOCATION
LOCATION
NUMBER
NAME
ADDRESS
CITY, STATE, ZIP
NEW EMPLOYEE
CHANGE
CERTIFICATED
CLASSIFIED
FOOD SERVICES
FEDERAL WITHHOLDINGS
I CLAIM EXEMPTION FROM FEDERAL WITHHOLDING
SINGLE
MARRIED
MARRIED, BUT WITHHOLD AT HIGHER SINGLE RATE
NOTE: IF MARRIED, BUT LEGALLY SEPARATED, OR SPOUSE IS A NONRESIDENT ALIEN, CHECK THE "SINGLE" BOX.
TOTAL NUMBER OF FEDERAL ALLOWANCES:
$
ADDITIONAL AMOUNT TO WITHHOLD FROM PAYCHECK:
STATE WITHHOLDINGS
I CLAIM EXEMPTION FROM STATE WITHHOLDING
SINGLE OR MARRIED (TWO OR MORE INCOMES)
MARRIED (ONE INCOME)
HEAD OF HOUSEHOLD
1. NUMBER OF REGULAR STATE ALLOWANCES:
2. NUMBER OF ADDITIONAL STATE ALLOWANCES:
3. TOTAL NUMBER OF STATE ALLOWANCES (LINE 1+LINE 2):
$
ADDITIONAL AMOUNT TO WITHHOLD FROM PAYCHECK - STATE:
UNDER PENALTIES OF PERJURY, I CERTIFY THAT I AM ENTITLED TO THE NUMBER OF WITHHOLDING ALLOWANCES CLAIMED ON THIS CERTIFICATE, OR I AM
ENTITLED TO CLAIM EXEMPT STATUS.
SIGNATURE:
DATE:
File this form with the Human Resource Services Division. If you expect to owe more tax than will be withheld, you may claim
fewer or zero allowances. If you had no tax liability last year and anticipate none this year, you may be exempt from income tax
withholding by checking the appropriate box on this card, to be filed each year.
Instructions for Form W-4 are available from the Internal Revenue Service (IRS). You can view their web site at
Instructions for Form DE 4 are available from the Employment Development Department, State of California. You can view their
web site at
Please refer any questions concerning withholding tax to the IRS (federal) and the Franchise Tax Board (state).
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