Form Nj-W4-P - Certificate Of Voluntary Withholding Of New Jersey Gross Income Tax From Pension And Annuity Payments - 1996

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CERTIFICATE OF VOLUNTARY WITHHOLDING
NJ-W-4P
(8-96)
OF NEW JERSEY GROSS INCOME TAX
FROM PENSION AND ANNUITY PAYMENTS
Type or Print Your Full Name
Your Social Security No.
Home Address (No. and Street or Rural Route)
__________ / _______ / __________
Claim or ID Number of Your Pension
City or Town
State
Zip Code
or Annuity Contract
I elect to have New Jersey Gross Income Tax withheld from each pension or annuity payment in the amount of
$
.00 (Minimum of $10.00 per payment or an even dollar amount greater than the minimum.)
Your Signature____________________________________________________ Date _______________________
FORM MAY BE REPRODUCED
- 14 -

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