Form Pw-4 - Employee'S Withholding Certificate For The City Of Portland Income Tax

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EMPLOYEE’S WITHHOLDING CERTIFICATE FOR THE CITY OF PORTLAND INCOME TAX
PW-4
Na
1. Print Full Name
Social Security Number
2. Address
City
State
Zip
Resident
Non Resident
3. Exemptions for yourself
EMPLOYEE: File this form with your
4. Exemptions for your spouse
employer. Otherwise, they must
withhold CITY OF PORTLAND income
tax from your earnings without
5. Exemptions for your children or other dependents
exemptions.
6. Add the number of exemptions which you have claimed on
EMPLOYER: Keep this certificate with
lines 3, 4, and 5 above and write the total
your records. If the information
submitted by the employee is not
believed to be true, correct and
7. Enter a dollar amount for extra withholding
complete, the Administrator must be
I certify that the information submitted on this certificate is true, correct and complete to
so advised.
the best of my knowledge and belief
Date
Signature
EMPLOYEE’S WITHHOLDING CERTIFICATE FOR THE CITY OF PORTLAND INCOME TAX
PW-4
Na
1. Print Full Name
Social Security Number
2. Address
City
State
Zip
Resident
Non Resident
3. Exemptions for yourself
EMPLOYEE: File this form with your
4. Exemptions for your spouse
employer. Otherwise, they must
withhold CITY OF PORTLAND income
tax from your earnings without
5. Exemptions for your children or other dependents
exemptions.
6. Add the number of exemptions which you have claimed on
EMPLOYER: Keep this certificate with
lines 3, 4, and 5 above and write the total
your records. If the information
submitted by the employee is not
believed to be true, correct and
7. Enter a dollar amount for extra withholding
complete, the Administrator must be
I certify that the information submitted on this certificate is true, correct and complete to
so advised.
the best of my knowledge and belief
Date
Signature
EMPLOYEE’S WITHHOLDING CERTIFICATE FOR THE CITY OF PORTLAND INCOME TAX
PW-4
Na
1. Print Full Name
Social Security Number
2. Address
City
State
Zip
Resident
Non Resident
3. Exemptions for yourself
EMPLOYEE: File this form with your
4. Exemptions for your spouse
employer. Otherwise, they must
withhold CITY OF PORTLAND income
tax from your earnings without
5. Exemptions for your children or other dependents
exemptions.
6. Add the number of exemptions which you have claimed on
EMPLOYER: Keep this certificate with
lines 3, 4, and 5 above and write the total
your records. If the information
submitted by the employee is not
believed to be true, correct and
7. Enter a dollar amount for extra withholding
complete, the Administrator must be
I certify that the information submitted on this certificate is true, correct and complete to
so advised.
the best of my knowledge and belief
Date
Signature

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