Form W-4 - Employee'S Withholding Allowance Certificate

Form W-4 (2015)

Page

Deductions and Adjustments Worksheet

Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.

Enter an estimate of your 2015 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state

and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1951) of your

income, and miscellaneous deductions. For 2015, you may have to reduce your itemized deductions if your income is over $309,900

and you are married filing jointly or are a qualifying widow(er); $284,050 if you are head of household; $258,250 if you are single and not

head of household or a qualifying widow(er); or $154,950 if you are married filing separately. See Pub. 505 for details

{

}

$12,600 if married filing jointly or qualifying widow(er)

Enter:

$9,250 if head of household

$6,300 if single or married filing separately

Subtract line 2 from line 1. If zero or less, enter “-0-”

Enter an estimate of your 2015 adjustments to income and any additional standard deduction (see Pub. 505)

Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to

Withholding Allowances for 2015 Form W-4 worksheet in Pub. 505.) .

Enter an estimate of your 2015 nonwage income (such as dividends or interest) .

Subtract line 6 from line 5. If zero or less, enter “-0-”

Divide the amount on line 7 by $4,000 and enter the result here. Drop any fraction .

Enter the number from the Personal Allowances Worksheet, line H, page 1 .

Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet,

also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1

Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)

Note. Use this worksheet only if the instructions under line H on page 1 direct you here.

Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)

Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if

you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more

than “3”

If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter

“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet .

Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to

figure the additional withholding amount necessary to avoid a year-end tax bill.

Enter the number from line 2 of this worksheet

Enter the number from line 1 of this worksheet

Subtract line 5 from line 4 .

Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here

Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed .

Divide line 8 by the number of pay periods remaining in 2015. For example, divide by 25 if you are paid every two

weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2015. Enter

the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck

Table 1

Table 2

Married Filing Jointly

All Others

Married Filing Jointly

All Others

If wages from LOWEST

Enter on

If wages from LOWEST

Enter on

If wages from HIGHEST

Enter on

paying job are—

line 2 above

paying job are—

line 2 above

paying job are—

line 7 above

paying job are—

line 7 above

$0 -

$6,000

$0 -

$8,000

$0 - $75,000

$600

$0 - $38,000

$600

6,001 -

13,000

8,001 -

17,000

75,001 - 135,000

1,000

38,001 -

83,000

1,000

13,001 -

24,000

17,001 - 26,000

135,001 - 205,000

1,120

83,001 - 180,000

1,120

24,001 -

26,000

26,001 -

34,000

205,001 - 360,000

1,320

180,001 - 395,000

1,320

26,001 -

34,000

34,001 -

44,000

360,001 - 405,000

1,400

395,001 and over

1,580

34,001 -

44,000

44,001 -

75,000

405,001 and over

1,580

44,001 -

50,000

75,001 -

85,000

50,001 -

65,000

85,001 - 110,000

65,001 -

75,000

110,001 - 125,000

75,001 -

80,000

125,001 - 140,000

80,001 - 100,000

140,001 and over

100,001 - 115,000

115,001 - 130,000

130,001 - 140,000

140,001 - 150,000

150,001 and over

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this

You are not required to provide the information requested on a form that is subject to the

form to carry out the Internal Revenue laws of the United States. Internal Revenue Code

Paperwork Reduction Act unless the form displays a valid OMB control number. Books or

sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your

records relating to a form or its instructions must be retained as long as their contents may

employer uses it to determine your federal income tax withholding. Failure to provide a

become material in the administration of any Internal Revenue law. Generally, tax returns and

properly completed form will result in your being treated as a single person who claims no

return information are confidential, as required by Code section 6103.

withholding allowances; providing fraudulent information may subject you to penalties. Routine

The average time and expenses required to complete and file this form will vary depending

uses of this information include giving it to the Department of Justice for civil and criminal

on individual circumstances. For estimated averages, see the instructions for your income tax

litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions

return.

for use in administering their tax laws; and to the Department of Health and Human Services

If you have suggestions for making this form simpler, we would be happy to hear from you.

for use in the National Directory of New Hires. We may also disclose this information to other

See the instructions for your income tax return.

countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal

laws, or to federal law enforcement and intelligence agencies to combat terrorism.

Form W-4 - Employee'S Withholding Allowance Certificate - 2015 Page 2

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