Form Va-4 - Personal Exemption Worksheet Page 2
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1
2FORM VA.4 INSTRUCTIONS
Use this form
to
notify
your emproyer whether you are subject to
Virginia
and how
many
exemptions you are allowed to claim.
you must file this form with your
employ
nt
begins. lf
you
do
not
file this form, your
employer must withhold Virginia income tax as
if
yo
PERSONAL EXEMPTION WORKSHEET
You may
not claim more personalexemptions on form
vA4
than you are allowed to claim on your income
tax return unless you have received written permission to do so
fiom
the Department of Taxation.
Line
1.
You
may claim an
exemption for yourself.
Line
2'
You
may claim an
exemption for your spouse if he or she is not already claimed on his or her
own
certificate.
Line
3
Enter
the number of dependents you are allowed to claim on your income tax
return.
NOTE:
A
spouse is not a dependent.
Line
5.
lf you
will be age 65 or over by January
1,
you may claim one exemption on Line 5(a). lf you claim
an
exenrption for
your spouse on Line
2,
and
your spouse will also
be
age
65 or over by January
1,
you may
claim an
additional exemption on Line
5(b).
Line
6
lf you
are legally blind, you may claim an exemption on Line 6(a). lf you claimed an exemption for your
spouse
on Line 2, and your spouse is legally blind, you may claim an exemption on Line
6(b).
FORM VA.4
Be sure to enter
your social security number, name and address in the spaces provideo
Line
1.
lf you are subject to
withholding, enter the number of exemptions
from:
(a)
Subtotal
of Personal Exemptions
-
line
4 of the Personal Exemption Worksheet
(b) Subtotal of Exemptions for Age and Blindness - line
7
of
the Personal Exemption Worksheet
(c) Total
Exemptions
-
line 8
of
the personal Exemption worksheet
Line
2.
lf
your
wish
to have additional tax withheld, and your employer has agreed to do so, enter the amount of
additional tax on
this
line.
Line
3.
lf you are not subject to Virginia
withholding, check the box on this line. You are not subject
to
withholding if
you nreet any one of
the conditions listed below. Form VA-4 must
be
filed with your employer
for each calendar year for
which you claim exemption from Virginia withholding.
(a)
Y:u
had
no liability for Virginia income tax last year and you do not expect to have any liability for
this
year.
(b)
V)u
expect your
Virginia adjusted gross income to be less than the amount shown below for vour filinq
status.
Taxable Years
2005, 2006
and 2007
Taxable Years
2008 and
2009
Taxable Years
2010
and
2011
Taxable Years
2Q12 and
Beyond
Single
$7,000
$11,250
$11 650
$11
,950
Married
$14,000
$22,500
$23,300
$23,900
Married,
filing
a separate
return
$7 000
$11,250
$11
,650
$11
,950
(c)
You live in Kentucky
or the District of Columbia and commute on a daily basis to your place of
ernployment
in
Virginia.
(d)
You
are
a
domiciliary or legal resident of Maryland, Pennsylvania or West Virginia whose only
Virginia source
income
is
from salaries and wages and such salaries and wages are subject
to income
taxation by your state of domicile.
Line
4.
Under
the Servicemember Civil
Relief
Act,
as
amended
by
the Military Spouses Residency
Relief
Act,
y,ou
may
be
exempt from
Virginia income tax on your wages
if (i)
your
spouse
is
a member
of
the armed forces present
in
Virginia
in
compliance
with military orders;
(ii)you
are present
in
Virginia solely
to
be
with your spouse;
and
(iii)
you maintain your domicile
in
another
state.
lf you claim exemption under the SCRA check the
box
on Line
4 and attach a copy of
yourspousal
military identification card
to FormVA-4.
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