Employee Development Department State Of California - Employee'S Withholding Allowance Certificate

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This form can be used to manually compute your
withholding allowances, or you can electronically
compute them at
EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE
Type or Print Your Full Name
Your Social Security Number
Home Address (Number and Street or Rural Route)
Filing Status Withholding Allowances
SINGLE or MARRIED (with two or more incomes)
City, State, and ZIP Code
MARRIED (one income)
HEAD OF HOUSEHOLD
1. Number of allowances for Regular Withholding Allowances, Worksheet A
Number of allowances from the Estimated Deductions, Worksheet B
Total Number of Allowances (A + B) when using the California
Withholding Schedules for 2016
OR
2. Additional amount of state income tax to be withheld each pay period (if employer agrees), Worksheet C
OR
3. I certify under penalty of perjury that I am not subject to California withholding. I meet the conditions set forth under
the Service Member Civil Relief Act, as amended by the Military Spouses Residency Relief Act.
(Check box here)
Under the penalties of perjury, I certify that the number of withholding allowances claimed on this certificate does not exceed the
number to which I am entitled or, if claiming exemption from withholding, that I am entitled to claim the exempt status.
Signature
Date
Employer’s Name and Address
California Employer Account Number
Cal Poly Corporation
91013797
1 Grand Avenue, Bldg. 15
San Luis Obispo, CA 93407
cut here
Give the top portion of this page to your employer and keep the remainder for your records.
YOUR CALIFORNIA PERSONAL INCOME TAX MAY BE UNDERWITHHELD IF YOU DO NOT FILE THIS DE 4 FORM.
IF YOU RELY ON THE FEDERAL FORM W-4 FOR YOUR CALIFORNIA WITHHOLDING ALLOWANCES, YOUR CALIFORNIA STATE
PERSONAL INCOME TAX MAY BE UNDERWITHHELD AND YOU MAY OWE MONEY AT THE END OF THE YEAR.
PURPOSE: This certificate, DE 4, is for California Personal Income
certificate for your state income tax withholding, you may
Tax (PIT) withholding purposes only. The DE 4 is used to compute
be significantly underwithheld. This is particularly true if your
the amount of taxes to be withheld from your wages, by your
household income is derived from more than one source.
employer, to accurately reflect your state tax withholding obligation.
CHECK YOUR WITHHOLDING: After your Form W-4
You should complete this form if either:
and/or DE 4 takes effect, compare the state income tax withheld
with your estimated total annual tax. For state withholding, use
(1) You claim a different marital status, number of regular allowances,
the worksheets on this form.
or different additional dollar amount to be withheld for California PIT
EXEMPTION FROM WITHHOLDING: If you wish to claim
withholding than you claim for federal income tax withholding or,
exempt, complete the federal Form W-4. You may claim exempt
(2) You claim additional allowances for estimated deductions.
from withholding California income tax if you did not owe
any federal income tax last year and you do not expect to owe
THIS FORM WILL NOT CHANGE YOUR FEDERAL
any federal income tax this year. The exemption is good for
WITHHOLDING ALLOWANCES.
one year. If you continue to qualify for the exempt filing status,
The federal Form W-4 is applicable for California withholding
a new Form W-4 designating EXEMPT must be submitted by
purposes if you wish to claim the same marital status, number
February 15 each year to continue your exemption. If you are not
of regular allowances, and/or the same additional dollar amount
having federal income tax withheld this year but expect to have
to be withheld for state and federal purposes. However, federal
a tax liability next year, you are required to give your employer a
tax brackets and withholding methods do not reflect state PIT
new Form W-4 by December 1.
withholding tables. If you rely on the number of withholding
allowances you claim on your Form W-4 withholding allowance
DE 4 Rev. 44 (1-16) (INTERNET)
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