Form Nj-W-4p - Certificate Of Voluntary Withholding Of New Jersey Gross Income Tax From Pension And Annuity Payments
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1Form NJ-W-4P
NJ-W-4P
CERTIFICATE OF VOLUNTARY WITHHOLDING OF NEW JERSEY GROSS INCOME TAX
(04-17)
FROM PENSION AND ANNUITY PAYMENTS
Print Your Full Name
Your Social Security Number
-
-
Home Address
ID Number of Your Pension or Annuity
(From Your Statement or Contact Your Payer):
City or Town
State
Zip Code
________________________
I want to have New Jersey Gross Income Tax withheld from this pension or annuity payment in the amount of
$
.00 (Enter a whole dollar amount of $10 or more for each payment.)
I want to stop withholding New Jersey Income Tax from this pension or annuity payment.
Your Signature
Date
MAIL THIS FORM TO YOUR PENSION OR ANNUITY PAYER
FORM MAY BE REPRODUCED
You can use Form NJ-W-4P to notify your pension payer to begin, change, or stop withholding New
Jersey Income Tax from your pension or annuity payments.
Note: If you previously completed this form, do not file again unless you want to make a change.
Instructions
Fill in your name, address, and Social Security Number;
Enter the identification number of your pension or annuity contract. If you do not find this
number on your annual pension or annuity statement, ask your pension plan administrator;
Check only one box. If you are requesting to have Income Tax withheld, you also must enter
the amount you want deducted from each payment;
Sign and date the completed form;
Mail this form to the payer of your pension or annuity. If you do not have the
mailing address, you must contact your payer.
For State of New Jersey retirees and benefit recipients only, visit the
New Jersey Division of Pensions
and Benefits
for mailing information.
Why should I file this form?
Your pension or annuity may be taxable and you may owe tax when you file your New Jersey
Income Tax return. Use this form to have the payer of your pension or annuity withhold New Jersey
Income Tax for you. If you choose not to withhold New Jersey Income Tax, you may be required to
make estimated tax payments.
Note: If you do not expect to owe Income Tax to New Jersey at the end of the tax year, do not
request to have New Jersey Income Tax withheld.
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