Form D-4a Certificate Of Nonresidence In The District Of Columbia
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1Form D-4A Certi cate of Nonresidence in the District of Columbia
Government of the
District of Columbia
Enter Year
First name
M.I. Last name
Temporary DC address (number and street)
Social security number
Permanent address (number and street)
Apartment number
City
State
Zip code + 4
Country or U.S. commonwealth
Signature
Under penalties of law, I certify that my permanent residence is not in DC and that I will not be residing in DC for 183 days or more in the tax year.
Signature
Date
Revised 02/2015
Instructions
Who must le a Form D-4A?
What if your resident status changes?
If you are not a resident of DC you must fi le a Form D-4A
If you become a DC resident any time after you have fi led
with your employer to establish that you are not subject to DC
a Form D-4A with your employer, you must fi le a Form D-4
income tax withholding. You qualify as a nonresident if:
promptly so that the proper amount of DC income tax can be
withheld from your wages.
• Your permanent residence is outside DC during all of
the tax year and you do not reside in DC for 183 days or
How do you le the Form D-4?
more in the tax year.
After completing this form, give it to your employer to keep
• You are a service member’s spouse.
on fi le.
Employees who are residents of DC should fi le a Form D-4,
DC Withholding Allowance Certifi cate.
05193
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Parent category: Legal