Form K-4e - Special Withholding Exemption Certificate

INSTRUCTIONS

Who May Claim the Exemption from Withholding of Income Tax—The

from other states municipal bonds and pension income from

employee may be entitled to claim exemption from withholding of

a qualifying lump-sum distribution. If your and your spouse’s

Kentucky income tax if no income tax liability is anticipated for the

combined modified gross income is expected to be less than the

current year. If the employee is eligible to claim this exemption,

threshold amount for your family size, then you and your spouse

the employer will not withhold Kentucky income tax from wages.

may complete this certificate. If the anticipated wages exceed

Employer: Do not accept if the employee’s wages exceed the income

these requirements, this certificate must not be filed.

requirements as shown below.

Multiple Employers—An employee, employed by more than

Liability for Estimated Tax—If income tax is not withheld by the

one employer, may claim the exemption from withholding

employer as a result of this certificate and an income tax liability

with each employer, provided that the total of the anticipated

occurs, estimated tax may be required. An estimated tax penalty

income does not exceed the threshold amount for the current

will be applicable if 70 percent of the tax due is not prepaid and the

taxable year.

liability is more than $500.

Expiration and Requirement of Revocation of the Exemption—This

Income Filing Requirements—The 2012 filing threshold amount

certificate will expire on the last day of the fourth month following

based upon federal poverty level is expected to be $11,170 for a

the close of the taxable year. This exemption certificate must be

family size of one (single, or married living apart from your spouse

revoked within 10 days if it is reasonable to anticipate that a Kentucky

for the entire year), $15,130 for a family of two (single with one

income tax liability will occur. If this exemption certificate is

dependent child or a married couple), $19,090 for a family of three

discontinued or revoked, a new Employee’s Withholding Exemption

(single with two dependent children or a married couple with one

Certificate (Form K-4) must be filed with the employer.

dependent child) and $23,050 for a family of four or more (single

with three or more dependent children or a married couple with

two or more dependent children). Modified gross income is equal

to your federal adjusted gross income plus any interest income

Form K-4e - Special Withholding Exemption Certificate - 2012 Page 2