Fillable Form Va-4 - Personal Exemption Worksheet (Page 2 of 2) in pdf

FORM VA-4 INSTRUCTIONS

Use this form to notify your employer whether you are subject to Virginia income tax withholding and how many

exemptions you are allowed to claim. You must file this form with your employer when your employment begins. If you

do not file this form, your employer must withhold Virginia income tax as if you had no exemptions.

PERSONAL EXEMPTION WORKSHEET

You may not claim more personal exemptions on form VA-4 than you are allowed to claim on your income

tax return unless you have received written permission to do so from the Department of Taxation.

Line 1. You may claim an exemption for yourself.

Line 2. You may claim an exemption for your spouse if he or she is not already claimed on his or her own

certificate.

Line 3. Enter the number of dependents you are allowed to claim on your income tax return.

NOTE: A spouse is not a dependent.

Line 5. If you will be age 65 or over by January 1, you may claim one exemption on Line 5(a). If you claim an

exemption for your spouse on Line 2, and your spouse will also be age 65 or over by January 1, you may

claim an additional exemption on Line 5(b).

Line 6. If you are legally blind, you may claim an exemption on Line 6(a). If you claimed an exemption for your

spouse on Line 2, and your spouse is legally blind, you may claim an exemption on Line 6(b).

FORM VA-4

Be sure to enter your social security number, name and address in the spaces provided.

Line 1. If you are subject to withholding, enter the number of exemptions from:

(a) Subtotal of Personal Exemptions - line 4 of the Personal Exemption Worksheet

(b) Subtotal of Exemptions for Age and Blindness - line 7 of the Personal Exemption Worksheet

Line 2. If you wish to have additional tax withheld, and your employer has agreed to do so, enter the amount of

additional tax on this line.

Line 3. If you are not subject to Virginia withholding, check the box on this line. You are not subject to withholding if

you meet any one of the conditions listed below. Form VA-4 must be filed with your employer

for each calendar year for which you claim exemption from Virginia withholding.

(a) You had no liability for Virginia income tax last year and you do not expect to have any liability for

this year.

(b) You expect your Virginia adjusted gross income to be less than the amount shown below for your filing

status:

Taxable Years

2005, 2006

2008 and

2010 and

2012 and

and 2007

2009

2011

Beyond

Single

$7,000

$11,250

$11,650

$11,950

Married

$14,000

$22,500

$23,300

$23,900

Married, filing a separate

$7,000

$11,250

$11,650

$11,950

return

employment in Virginia.

(d) You are a domiciliary or legal resident of Maryland, Pennsylvania or West Virginia whose only

Virginia source income is from salaries and wages and such salaries and wages are subject

to income taxation by your state of domicile.

Line 4. Under the Servicemember Civil Relief Act, as amended by the Military Spouses Residency Relief Act, you may

be exempt from Virginia income tax on your wages if (i) your spouse is a member of the armed forces present

in Virginia in compliance with military orders; (ii) you are present in Virginia solely to be with your spouse; and

(iii) you maintain your domicile in another state. If you claim exemption under the SCRA check the box on Line

4 and attach a copy of your spousal military identification card to Form VA-4.

Form Va-4 - Personal Exemption Worksheet Page 2

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