Form Ar4ec - Employee'S Withholding Exemption Certificate printable pdf download

Arkansas Income Tax Section

For further information, consult your employer or

Withholding

P. O. Box 8055

Little Rock, Arkansas 72203-8055

STATE OF ARKANSAS

AR4EC

Employee’s Withholding Exemption Certificate

Social Security

Print Full Name ____________________________________________Account Number ____________________________________________________

Print Home Address _________________________________________City ____________________State_________________Zip _________________

How to Claim Your Withholding

No. of exemptions

EMPLOYEE:

Instructions on Reverse Side

claimed

File this form with

CHECK ONE OF THE FOLLOWING FOR EXEMPTIONS CLAIMED

your employer.

(a) You claim yourself. (Enter one exemption). ...........................................................................

Otherwise, employer

(b) You claim yourself and your spouse. (Enter two exemptions). ..............................................

must withhold state

income tax from your

wages without

NUMBER OF CHILDREN or DEPENDENTS.(Enter one exemption per dependent). .......................

exemptions or depen-

TOTAL EXEMPTIONS. (Add Lines 1a, b, c, and 2).

dents.

If no exemptions or dependents are claimed, enter zero. ................................................................

EMPLOYER:

Additional amount, if any, you want deducted from each paycheck.(Enter dollar amount).. ...........

Keep this certificate

I qualify for the low income tax rates. (See reverse for details).. ....................................................

with your records.

Please check filing status:

Single

Married

Head of Household

I certify that the number of dependents and exemptions claimed on this certificate does not exceed the number to which I am entitled.

Signature: _________________________________________________________Date: ______________________________________

1. NUMBER OF EXEMPTIONS - (Husband and/or Wife) Do not claim more than

3. CHANGES IN EXEMPTIONS OR DEPENDENTS - You may file a new certifi-

the correct number of exemptions. However, if you expect to owe more income tax

cate at any time if the number of exemptions or dependents INCREASES. You

for the year, you may increase your withholding by claiming a smaller number of

must file a new certificate within 10 days if the number of exemptions or depen-

exemptions and/or dependents, or you may enter into an agreement with your

dents previously claimed by you DECREASES for any of the following reasons:

employer to have additional amounts withheld. This is especially important if you

(a) Your spouse for whom you have been claiming an exemption is divorced

have more than one employer, or if both husband and wife are employed.

or legally separated, or claims his or her own exemption on a separate certifi-

cate, or

2. DEPENDENTS - To qualify as your dependent (line 1 on the reverse side), a

(b) The support of a dependent for whom you claimed an exemption is expect-

person must (a) receive more than 1/2 of their support from you for the year, (b)

ed to be less than half of the total support for the year.

not be claimed as a dependent by such person's spouse, (c) be a citizen or resi-

OTHER DECREASES in exemptions or dependents, such as the death of a

dent of the United States, and (d) have your home as their principle residence and

spouse or a dependent, do not affect your withholding until next year, but require

be a member of your household for the entire year or be related to you as follows:

the filing of a new certificate by December 1, of the year in which they occur.

son, daughter, grandchild, stepson, stepdaughter, son-in-law or daughter-in-law;

4. Claim additional amounts of withholding tax if desired. This will apply most

Your father, mother, grandparent, stepfather, stepmother, father-in-law or mother-

often when you have income other than wages.

in-law; Your brother, sister, stepbrother, stepsister, half brother, half sister, broth-

5. You qualify for the low income tax rates if your total income from all sources

er-in-law or sister-in-law; Your uncle, aunt, nephew or niece (but only if related

are as shown below:

by blood).

(a) Single....................................................... ........... $7,800 to $11,400

(b) Married filing jointly................................ ............ $15,500 to $16,200

AR4EC (R 11/99)

Form Ar4ec - Employee'S Withholding Exemption Certificate

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