Form Sf W-4 - Employees Witholding Certificate For The City Of Springfield Income Tax

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Instructions for employee withholding certificate
Dependents - To qualify as your dependent (line
Other Decreases - in exemptions, such as the
7a ) a person must qualify as your dependent as
death of a spouse or dependent, do not affect
provided in the Federal Internal Revenue Code.
your withholdings until the next year but require
the filing of a new certificate by December 1 of the
year in which they occur.
Changes in Exemptions - You should file a new
certificate
any
time
the
number
of
your
Change of Residence - You must file a new
exemptions increases. You must file a new
certificate within 10 days after you change your
certificate within 10 days if the number of
residence from or to a taxing city.
exemptions
previously
claimed
by
you
DECREASES.
Additional withheld
-
You may designate additional
withholding if you expect to owe more than the amount
withheld.
EMPLOYEES WITHOLDING CERTIFICATE
SF W-4
Print Form
FOR THE CITY OF SPRINGFIELD INCOME TAX
1. Print full name
2. Social Security Number
3. Springfield Resident?
Yes
No
4. Address
City, Township or Village where you reside State
Zip Code
Michigan
Check boxes that apply
Employee - File this form
5. Exemptions for yourself:
Regular
Age 65 & older
Blind
Deaf
Enter number of
with your employer,
Exemption
or Disabled
exemptions checked
otherwise your employer
must withhold Springfield
6. Exemptions for your
Regular
Age 65 & older
Blind
Deaf
Enter number of
spouse:
Exemption
or Disabled
exemptions checked
income tax from your
earnings without exemptions.
7a. Exemptions for your children Number
7b. Exemptions for your other dependents Number
Enter total of line
7 (a plus b)
Employer - Keep this
Total
8. Add the number of exemptions which you have claimed on lines 5, 6, 7 a & b above and write the total.
certificate with your records.
If the information submitted
by the employee is not
8. Additional amount you want deducted from each pay (if employer agrees)
believed to be true, correct
and complete, the Springfield
I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
Income Tax Department must
Date
Signature
be so advised.

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