Form Lw-4 - Employee'S Withholding Certificate For City Of Lapeer Income Tax
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1LW-4
___
RESIDENT
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF LAPEER INCOME TAX
___
NONRESIDENT
1. Print Full Name
Social Security #
Office, Plant, Department
Employee Identification #
2. Address, Number and Street
City, Township or Village
State
Zip Code
MI
3. Predominant Place of Employment
City
Print Name of each city where you work
Under 25%
40%
60%
80%
100%
for this employer and circle % of total
City
earnings of each.
Under 25%
40%
60%
80%
100%
4. Exemption for
Regular $600
Additional exemption
Additional exemption
Enter Number of
YOUR WITHHOLDING
yourself:
exemption
if 65 or over at end of year
if blind
Exemptions Checked:
EXEMPTIONS:
5. Exemption for
Regular $600
Additional exemption
Additional exemption
Enter Number of
Check blocks which apply
spouse:
exemption
if 65 or over at end of year
if blind
Exemptions Checked:
6. (a) Exemptions for
Number
6. (b) Exemptions for your
Number
Enter total of Line 6
EMPLOYEE: File this form with
your children
other dependents
(a+b)
your employer. Otherwise he must
withhold City of Lapeer Income Tax
7. Add the number of exemptions which you have claimed on lines 4, 5 and 6 above and write the total
from your earnings without
exemption.
8. Additional amount you want deducted from each pay (if employer agrees)
EMPLOYER: Keep this certificate
.00
with your records. If the information
I certify that the information submitted on this certificate is true, correct, and complete to the best of my knowledge and
submitted by the employee is not
belief.
believed to be true; correct and
9. Date
Signature:
complete the form, and the City
must be advised.
FORM LW-4 - INSTRUCTIONS FOR COMPLETING EMPLOYEE’S WITHHOLDING CERTIFICATE
•
GENERAL INSTRUCTIONS-Check the line in the upper
Your uncle, aunt, nephew or niece (but only if
right hand corner to indicate your residency status and
related by blood).
enter the requested data on lines 1 and 2
CHANGES IN EXEMPTIONS: You should file a new
LINE 3 INSTRUCTIONS: If you work for this employer
certificate at any time if the number of your exemptions
in more than two cities or communities, print names of
INCREASES. You must file a new certificate within 10
the two Michigan cities or communities where you
days if the number of exemptions previously claimed by
perform the greatest percent of your work. Circle the
you DECREASES for any of the following reasons:
closest percent of total earnings for work done or
(a) Your wife (or husband) for whom you have been
services rendered in each city or community listed. The
claiming exemption is divorced or legally separated
estimated percent of total earnings from this employer
or claims her (or his) own exemption on a separate
for work done or services performed within taxing cities
certificate.
is for withholding purposes only. In determining final tax
(b)
The support of a dependent for whom you
liability this estimate is subject to substantiation and
claimed exemption is taken over by someone else
audit.
so that you no longer expect to furnish more than
half the support for the year.
DEPENDENTS; To qualify as your dependent (line6), a
(c) You find that a dependent for whom you claimed
person (a) must receive more than one-half of his or her
exemption will receive $600 or more of income on
support from you for the year, and (b) must have less
his own during the year (except your child who is a
than $600 gross income during the year (except your
student who is under 19 years of age).
child who is a student or who is under 19 years of age),
and (c) must not be claimed as an exemption by such
OTHER DECREASES in exemption, such as the death
person's husband or wife, and (d) must be a citizen or
of a wife or a dependent, do not affect your withholding
resident of the United States or a resident of Canada,
until the next year, but require the filing of a new
Mexico, the Republic of Panama, or the Canal Zone (this
certificate by December 1 of the year in which they
does not apply to an alien child legally adopted by and
occur.
living with a United States citizen abroad), and (e) must
(1) have your home as his principal residence and be a
CHANGE OF RESIDENCE- You must file a new
member of your household for the entire year, or (2) be
certificate within 10 days after you change your
related to you as follows:
residence from or to a taxing city.
•
Your son or daughter (including legally adopted
CHANGES IN EMPLOYMENT – You must file a new
children), grandchild, stepson, stepdaughter, son-in-
certificate by December 1 of each year if your Line 3
law, or daughter-in-law;
estimate of the percent of work done or services to be
•
rendered in cities levying an income tax will change for
Your
father,
mother,
grandparent,
stepfather,
the ensuing year.
stepmother, father-in-law, or mother-in-law;
•
Your brother, sister, stepbrother, stepsister, half
brother, half sister, brother-in-law, or sister-in-law;
Revised 8-1-08
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