Form K-4c - Kansas Nonresident Employee Certificate For Allocation Of Withholding Tax
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1K-4C
KANSAS NONRESIDENT EMPLOYEE CERTIFICATE
for Allocation of Withholding Tax
(Rev. 9/05)
Employee’s Name
Social Security Number
Percent Subject to
Withholding
Home Address (Number and Street, or Rural Route and Box Number)
City
State
Zip Code
Employer’s Name
City
State
I hereby certify that I am a nonresident of the state of Kansas and reside at the address stated above. I estimate that the above
percentage of my compensation from the employer with whom I file this certificate is for services subject to Kansas income tax
withholding. I will notify my employer by filing another Form K-4C within ten (10) days of any substantial change in either the
proportion or in Kansas residency status.
Signature of Employee
Date
Employee: File this certificate with your employer. Do not send it to the Kansas Department of Revenue.
Employer: Retain this certificate with your withholding tax records. You may withhold on the basis of this certificate, but you must make
any necessary adjustments during the year so that the proper amount is withheld from the employee. The percentage
indicated on Form K-4C does not determine the amount of Kansas wages or other compensation to be reported on the
Form W-2.
Form K-4C may be downloaded from our web site, , or ordered from our voice mail forms request line, (785) 296-4937.
If you have questions about withholding tax or completing this form, write to the Kansas Department of Revenue, Taxpayer Assistance
st
Center, 915 SW Harrison, 1
Floor, Topeka, Kansas 66625-2007 or call (785) 368-8222; hearing impaired TTY (785) 296-6461. If you
prefer you may fax your questions to the Department of Revenue at (785) 291-3614.
K-4C
KANSAS NONRESIDENT EMPLOYEE CERTIFICATE
for Allocation of Withholding Tax
(Rev. 9/05)
Employee’s Name
Social Security Number
Percent Subject to
Withholding
Home Address (Number and Street, or Rural Route and Box Number)
City
State
Zip Code
Employer’s Name
City
State
I hereby certify that I am a nonresident of the state of Kansas and reside at the address stated above. I estimate that the above
percentage of my compensation from the employer with whom I file this certificate is for services subject to Kansas income tax
withholding. I will notify my employer by filing another Form K-4C within ten (10) days of any substantial change in either the
proportion or in Kansas residency status.
Signature of Employee
Date
Employee: File this certificate with your employer. Do not send it to the Kansas Department of Revenue.
Employer: Retain this certificate with your withholding tax records. You may withhold on the basis of this certificate, but you must make
any necessary adjustments during the year so that the proper amount is withheld from the employee. The percentage
indicated on Form K-4C does not determine the amount of Kansas wages or other compensation to be reported on the
Form W-2.
Form K-4C may be downloaded from our web site, , or ordered from our voice mail forms request line, (785) 296-4937.
If you have questions about withholding tax or completing this form, write to the Kansas Department of Revenue, Taxpayer Assistance
st
Center, 915 SW Harrison, 1
Floor, Topeka, Kansas 66625-2007 or call (785) 368-8222; hearing impaired TTY (785) 296-6461. If you
prefer you may fax your questions to the Department of Revenue at (785) 291-3614.
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