Form K-4 - Employee'S Withholding Exemption Certificate

ADVERTISEMENT

CUT ALONG DOTTED LINE
Revenue Form K-4
KENTUCKY DEPARTMENT OF REVENUE
Payroll No.
42A804 (11-13)
EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE
Print Full Name
Social Security No.
Print Home Address
HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS
0
EMPLOYEE:
1. If SINGLE, and you claim an exemption, enter "1," if you do not, enter "0" ........................................................................................
2. If MARRIED, one exemption each for you and spouse if not claimed on another certificate.
Failure to file this form with
(a) If you claim both of these exemptions, enter "2"
0
your employer will result in
(b) If you claim one of these exemptions, enter "1"
..................................................................................................................
withholding tax deductions
(c) If you claim neither of these exemptions, enter "0"
from your wages at the
3. Exemptions for age and blindness (applicable only to you and your spouse but not to dependents):
maximum rate.
(a) If you or your spouse will be 65 years of age or older at the end of the year, and you claim this
0
exemption, enter "4"; if both will be 65 or older, and you claim both of these exemptions, enter "8" ...........................................
(b) If you or your spouse are blind, and you claim this exemption, enter "4"; if both are blind, and you
0
claim both of these exemptions, enter "8" ....................................................................................................................................
EMPLOYER:
0
4. If you claim exemptions for one or more dependents, enter the number of such exemptions ............................................................
5. National Guard exemption (see instruction 1) .....................................................................................................................................
0
Keep this certificate with
6. Exemptions for Excess Itemized Deductions (Form K-4A) .................................................................................................................
your records.
7. Add the number of exemptions which you have claimed above and enter the total ...........................................................................
8. Additional withholding per pay period under agreement with employer. See instruction 1 .................................................................
$
I certify that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled.
Date
Signed
1833

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go