Form Ct-W4 - Employee'S Withholding Certificate

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State of Connecticut
FORM CT-W4

Department of Revenue Services
Effective July 1, 1998
Purpose. Complete Form CT-W4 so that your employer can withhold the correct
To Avoid Underwithholding. You could be underwithheld if any of the following
apply:
amount of Connecticut income tax from your pay. Underwithholding may result in
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you have more than one job;
interest charges at the rate of 1% (.01) per month or fraction thereof. If you are
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you qualify under the Special Rules For Certain Married
newly hired, your employer must, within 20 days, send a copy of this form to the
Individuals, and do not use the supplemental table;
Department of Labor pursuant to Conn. Gen. Stat. §31-254b.
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you have substantial nonwage income;
you were not employed during the first 6 months of 1998; or
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General Instructions. Complete the certificate below, sign it, and return it to
your income increased substantially during the last 6 months
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your employer. Refer to IP 92(9.5), Is My Connecticut Withholding Correct? , to
of 1998.
check the amount of your Connecticut income tax withholding. Additional
If you could be underwithheld, you should consider adjusting your withholding or
information is provided on back of this form.
making estimated payments on Form CT-1040ES, Estimated Connecticut Income
Exemption From Withholding. Read Line 4 of the certificate below to see if
Tax Payment Coupon for Individuals . You may also wish to select Filing Status “D” to
elect the highest level of withholding.
you can claim exempt status. If you are exempt, complete Line 4, but do not
Nonresident Employees who work partly within and partly outside of Connecticut,
complete Lines 2 and 3. Sign the form and return it to your employer. Connecticut
income tax will not be withheld from your pay. However, the Department of Revenue
see information on back of this form.
Services may review any Form CT-W4 claiming exemption from withholding.
Filing Status Worksheet
Check one box for filing status and enter letter on Line 1 below:
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A.
You are single; or
You are married and you are filing separately; or
You are married filing jointly, both you and your spouse work, and your combined income is $100,500 or less.
(Refer to Special Rules For Certain Married Individuals on Page 2.)
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B.
You will file as a head of household on your federal tax return.
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C.
You are married filing jointly and your spouse is not employed.
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D.
You are married filing jointly, have a working spouse, and your combined income is more than $100,500; or
You have a significant nonwage income, and wish to avoid having too little tax withheld; or
You are a nonresident and you have substantial other income.
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E.
You are exempt because you qualify on Line 4 below.
000COMPLETE SCHEDULE BELOW - Please Print Clearly000

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CUT HERE AND GIVE THE CERTIFICATE TO YOUR EMPLOYER. KEEP THE TOP PORTION FOR YOUR RECORDS
EMPLOYEE’S WITHHOLDING OR
State of Connecticut
CT-W4
FORM
EXEMPTION CERTIFICATE
Department of Revenue Services
1. Filing Status (Enter letter from box checked above) .................................................................................................. 1_____________________
2. Additional withholding amount per pay period ............................................................................................................ 2. ____________________
3. Reductional withholding amount per pay period ......................................................................................................... 3. ____________________
4. I claim exemption from withholding and I certify that I meet the following condition for exemption:
This year I expect a refund of ALL Connecticut income tax withheld because I expect to have NO Connecticut income tax liability.
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If you meet the above condition, check here to claim exemption from withholding ................................... 4.
FIRST NAME
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LAST NAME
YOUR SOCIAL SECURITY NUMBER
HOME ADDRESS
CITY/TOWN
STATE
ZIP CODE
DATE
EMPLOYEE’S SIGNATURE
M
M
D D
Y
Y
Employers Must Complete items 5 through 14. Please print clearly.
DATE
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. Is this a new or rehired employee?
Yes
No
If yes, provide the date of hire
5
M
M
D D
Y
Y
6. EMPLOYER’S BUSINESS NAME
9. Connecticut Tax Registration Number
7. EMPLOYER’S BUSINESS ADDRESS
10. Federal Employer Identification Number
8. CITY/TOWN
11. STATE
12. ZIP CODE
13. CONTACT PERSON
14. TELEPHONE NUMBER
Employer Instructions On Reverse
(Rev. 7/98)

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