Form Bcw-4 - Employee Withholding Certificate For City Of Battle Creek Income Tax
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1BCW-4
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF BATTLE CREEK INCOME TAX
IF YOU RESIDE IN THE CITY PLACE AN "R" IN THE BOX.
IF YOU RESIDE OUTSIDE THE CITY PLACE AN "N" IN THE BOX:
1.
Print Full Name
Social Security No.
Office, Plant, Dept.
Employee ID Number
2.
Address, Number and Street
City, Township or Village where you reside
State
Zip Code
3.
Predominant Place of Employment
City
Under
Print name of each city where you work for this
25%
40%
60%
80%
100%
employer and circle closet % of total earnings
City
Under
in each
25%
40%
60%
80%
100%
}
Check
4. Exemptions for
❑YOURSELF
❑ 65 & Over
❑ Disabled
Enter Total
YOUR WITHHOLDING
blocks
❑Blind
❑ Deaf
number
EXEMPTIONS:
which
5. Exemptions
❑SPOUSE
❑ 65 & Over
❑ Disabled
Enter total
apply
❑Blind
❑ Deaf
number
6. (a) Exemptions for
Number 6. (b) Exemptions for your
Number
Enter Total
EMPLOYEE:
File this form with your
your children
other dependents
6. (a) & (b)
employer. Otherwise he must withhold
CITY OF BATTLE CREEK income tax
7. Add the number of exemptions which have claimed on lines 4, 5 & 6 above
-------------------------------------
from your earnings without exemptions.
I certify that the information submitted on this certificate is true, correct and complete
EMPLOYER:
Keep this certificate with
to the best of my knowledge and belief.
your records. If the information submitted
8. Date
Signature
by the employee is not believed to be
19
true, correct and complete advise the City.
BCW-4
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF BATTLE CREEK INCOME TAX
IF YOU RESIDE IN THE CITY PLACE AN "R" IN THE BOX.
IF YOU RESIDE OUTSIDE THE CITY PLACE AN "N" IN THE BOX:
1.
Print Full Name
Social Security No.
Office, Plant, Dept.
Employee ID Number
2.
Address, Number and Street
City, Township or Village where you reside
State
Zip Code
3.
Predominant Place of Employment
City
Under
Print name of each city where you work for this
25%
40%
60%
80%
100%
employer and circle closet % of total earnings
City
Under
in each
25%
40%
60%
80%
100%
}
Check
4. Exemptions for
❑YOURSELF
❑ 65 & Over
❑ Disabled
Enter Total
YOUR WITHHOLDING
blocks
❑Blind
❑ Deaf
number
EXEMPTIONS:
which
5. Exemptions
❑SPOUSE
❑ 65 & Over
❑ Disabled
Enter total
apply
❑Blind
❑ Deaf
number
6. (a) Exemptions for
Number 6. (b) Exemptions for your
Number
Enter Total
EMPLOYEE:
File this form with your
your children
other dependents
6. (a) & (b)
employer. Otherwise he must withhold
CITY OF BATTLE CREEK income tax
7. Add the number of exemptions which have claimed on lines 4, 5 & 6 above
-------------------------------------
from your earnings without exemptions.
I certify that the information submitted on this certificate is true, correct and complete
EMPLOYER:
Keep this certificate with
to the best of my knowledge and belief.
your records. If the information submitted
8. Date
Signature
by the employee is not believed to be
19
true, correct and complete advise the City.
BCW-4
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF BATTLE CREEK INCOME TAX
IF YOU RESIDE IN THE CITY PLACE AN "R" IN THE BOX.
IF YOU RESIDE OUTSIDE THE CITY PLACE AN "N" IN THE BOX:
1.
Print Full Name
Social Security No.
Office, Plant, Dept.
Employee ID Number
2.
Address, Number and Street
City, Township or Village where you reside
State
Zip Code
3.
Predominant Place of Employment
City
Under
Print name of each city where you work for this
25%
40%
60%
80%
100%
employer and circle closet % of total earnings
City
Under
in each
25%
40%
60%
80%
100%
}
Check
4. Exemptions for
❑YOURSELF
❑ 65 & Over
❑ Disabled
Enter Total
YOUR WITHHOLDING
blocks
❑Blind
❑ Deaf
number
EXEMPTIONS:
which
5. Exemptions
❑SPOUSE
❑ 65 & Over
❑ Disabled
Enter total
apply
❑Blind
❑ Deaf
number
6. (a) Exemptions for
Number 6. (b) Exemptions for your
Number
Enter Total
EMPLOYEE:
File this form with your
your children
other dependents
6. (a) & (b)
employer. Otherwise he must withhold
CITY OF BATTLE CREEK income tax
7. Add the number of exemptions which have claimed on lines 4, 5 & 6 above
-------------------------------------
from your earnings without exemptions.
I certify that the information submitted on this certificate is true, correct and complete
EMPLOYER:
Keep this certificate with
to the best of my knowledge and belief.
your records. If the information submitted
8. Date
Signature
by the employee is not believed to be
true, correct and complete advise the City.
19
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