Form Ar4ec - Employee'S Withholding Exemption Certificate

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AR4EC
STATE OF ARKANSAS
Employee’s Withholding Exemption Certificate
Print Full Name ________________________________________________ Social Security Number ____________________________________
Print Home Address _____________________________________________ City _____________________________State _____ Zip _________
How to Claim Your Withholding
Number of Exemptions
Claimed
See instructions below
Employee:
1. CHECK ONE OF THE FOLLOWING FOR EXEMPTIONS CLAIMED
File this form with
your employer.
a.
You claim yourself. (Enter one exemption) ......................................................................1a
Otherwise, your
b.
You claim yourself and your spouse. (Enter two exemptions) .........................................1b
employer must
withhold state
c.
Head of Household, and you claim yourself. (Enter two exemptions) .............................1c
income tax from
your wages without
2. NUMBER OF CHILDREN or DEPENDENTS. (Enter one exemption per dependent) ................. 2
exemptions or
dependents.
3. TOTAL EXEMPTIONS. (Add Lines 1a, b, c, and 2)
If no exemptions or dependents are claimed, enter zero .............................................................. 3
Employer:
Keep this certificate
4. Additional amount, if any, you want deducted from each paycheck. (Enter dollar amount) ......... 4
with your records.
5. I qualify for the low income tax rates. (See below for details) ....................................................... 5
Yes
No
Please check filing status:
Single
Married Filing Jointly
Head of Household
I certify that the number of exemptions and dependents claimed on this certificate does not exceed the number to which I am entitled.
Signature: ______________________________________________________________________________________Date: _________________
Instructions
TYPES OF INCOME - This form can be used for withholding on all types
(a) Your spouse for whom you have been claiming an
of income, including pensions and annuities.
exemption is divorced or legally separated from you, or claims
his or her own exemption on a separate certificate, or
NUMBER OF EXEMPTIONS – (Husband and/or Wife) Do not claim more
(b) The support you provide to a dependent for whom you claimed
than the correct number of exemptions. However, if you expect to owe more
an exemption is expected to be less than half of the total support for the year.
income tax for the year, you may increase your withholding by claiming a
OTHER DECREASES in exemptions or dependents, such as the death of a
smaller number of exemptions and/or dependents, or you may enter into an
spouse or a dependent, does not affect your withholding until next year, but
requires the filing of a new certificate by December 1 of the year in which
agreement with your employer to have additional amounts withheld. This is
especially important if you have more than one employer, or if both husband
they occur.
and wife are employed.
You may claim additional amounts of withholding tax if desired. This will
DEPENDENTS – To qualify as your dependent (line 2 of form), a person
apply most often when you have income other than wages.
must (a) receive more than 1/2 of their support from you for the year, (b)
not be claimed as a dependent by such person’s spouse, (c) be a citizen
You qualify for the low income tax rates if your total income from all
or resident of the United States, and (d) have your home as their principal
sources is:
residence and be a member of your household for the entire year or be
(a) Single
$11,222
to
$14,800
related to you as follows: son, daughter, grandchild, stepson, stepdaughter,
(b) Married Filing Jointly
$18,923
to
$23,600
son-in-law or daughter-in-law; your father, mother, grandparent, stepfather,
(1 or less dependents)
(c) Married Filing Jointly
$22,774
to
$29,400
stepmother, father-in-law or mother-in-law; your brother, sister, stepbrother,
(2 or more dependents)
stepsister, half brother, half sister, brother-in-law or sister-in-law; your uncle,
(d) Head of Household/Qualifying Widow(er)
$15,953
to
$20,800
(1 or less dependents)
aunt, nephew or niece (but only if related by blood).
(e) Head of Household/Qualifying Widow(er)
$19,017
to
$23,500
(2 or more dependents)
CHANGES IN EXEMPTIONS OR DEPENDENTS – You may file
a new certificate at any time if the number of exemptions or dependents
For additional information consult your employer or write to:
INCREASES. You must file a new certificate within 10 days if the number
Arkansas Withholding Tax Section
P. O. Box 8055
of exemptions or dependents previously claimed by you DECREASES for
Little Rock, Arkansas 72203-8055
any of the following reasons:
AR4EC (R 12/10/12)

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