Form G-4 - State Of Georgia Employee'S Withholding Allowance Certificate Page 2
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1
2INSTRUCTIONS FOR COMPLETING FORM G-4
Enter your
full
name, address and social security
number in
boxes
I
a through 2b.
Line 3: Write the
number
of allowances you
are
claiming
in the
brackets
beside your marital status.
A.
Single- enter
I if
your are
claiming
yourself
B.
Married
Filing
Joint, both
spouses working-enter
I
if you claim yourself
C.
Married Filing
Joint,
one spouse working- enter I if your
claim
yourself or 2 if
you
claim yourself and your spouse
D.
Married
Filing Separate- enter
I
if you
claim
yourself
E.
Head
of
Household
-enter
I if you
claim yourself
Line
4:
Enter the
number
of dependent
allowances
you are entitled
to
claim.
H
Line
5:
Complete the
worksheet
on
Form
G-4
if
you
claim additional allowances. Enter
the number
on Line
here.
Failure to complete
and
submit the worksheet will result in automatic denial on
your
claim.
Line 6: Enter a specific
dollar
amount that you authorize your employer to withhold in addition
to
the
tax
withheld
based
on your
marital status and
number of
allowances.
Line
7: Enter the
letter
of your marital
status
from
Line 3.
Enter total of the
numbers
on Lines 3-5.
Line8:
a)
Check
the
first
box
if you
qualify to
claim exempt from withholding.
You
can
claim
exempt
if
you
filed
a Georgia
income
tax
return
last
year and
the
amount of
Line
4 of
Form
500EZ or Line 16 ofForm 500 was zero,
and
you expect
to
file a
Georgia tax
return
this year and will
not have
a tax
liability.
You can
not
claim exempt if
you did not
file a
Georgia
income
tax
return for the previous tax
year.
Receiving a refund in the previous tax
year
does not qualify
you
to claim exempt.
EXAMPLES:
Your employer withheld $500 of Georgia
income tax from
your wages.
The
amount on Line
4
of
Form
500EZ (or
Line
16
of Form 500)
was $100.
Your tax liability is the amount
on Line
4
(or Line
16); therefore,
you
do
not qualify to claim
exempt.
Your
employer withheld $500 of Georgia
income tax
from your wages. The amount on Line
4
of
Form 500EZ
(or Line
16 of
Form
500) was $0 (zero).
Your tax liability
is
the
amount on Line
4 (or
Line
16)
and you filed a
prior
year income
tax return;
therefore
you
qualify to
claim exempt.
b)
Check
the second box if
you are
not
subject
to
Georgia withholding and
meet the conditions
set
forth under
the
Servicemembers
Civil
Relief
Act,
as amended by the Military
Spouses
Residency Relief
Act. Under
the
Act, a spouse of
a servicemember
may be
exempt from Georgia
income ta
x
on
income from
services
performed in
Georgia if:
1.
The servicemember
is
present
in
Georgia
in compliance
with
military
orders;
2.
The spouse
is
in Georgia solely to
be
with
the
servicemember;
3.
The
spouse maintains
domicile in another state; and
4.
The domicile of
the spouse
is
the
same
as
the domicile
of
the
servicemember.
Additional
information for
employers
regarding the Military Spouses Residency Relief Act:
1.
On
theW-2 for 2010
and any year thereafter, the employer should not
report
any of
the
wages as Georgia wages
on
the W-2.
2.
If the
spouse of a servicemember is entitled
to the protection
of
the Military
Spouses
Residency Relief Act
in
another state and
files
a withholding
exemption
form
in
such other state,
the
spouse
is
required
to
submit a
Georgia Form
G-4
so
that withholding
will occur as is required
by
Georgia Law when a Georgia domiciliary
works in another state and withholding is
not required by
such
other
state.
If the
spouse
does not fill out the
form,
the
employer shall withhold
Georgia
income
tax
as
if the
spouse
is
single with zero allowances.
3-7
Do not complete Lines
if claiming exempt.
§
O.C.G.A.
48-7-102
requires you to complete and submit Form G-4 to your
employer
in order
to have
tax withheld from
your wages.
By
correctly completing
this
form, you can adjust
the
amount of
tax
withheld to
meet
your
tax
liability.
Failure
to submit
a properly completed
Form
G-4 will result in your employer withholding
tax
as
though
you are single
with
zero
allowances.
Employers are
required to mail
any Form G-4 claiming
more than 14
allowances or
exempt from
withholding
to the
Georgia
Department
of
Revenue for
approval. Employers will
honor the properly completed form as
submitted pending notification
from
the
Withholding Tax Unit. Upon approval, such forms remain
in
effect
until
changed or
unti
l
February
15
of the
following
year. Employers who
know that
a G-4 is
erroneous
should
not honor the
form and
should
withhold as if the
employee is single claiming
zero
allowances until a corrected
form has been received
.
Page 10
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