Form Gr W-4 - Employee'S Withholding Certificate For City Of Grayling Income Tax
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1
2❒ RESIDENT
GR W-4
Employee’s Withholding Certificate For City of Grayling
Income Tax
❒ NON-RESIDENT
1. Print Full Name
Employee Identification No.
Social Security No.
Office, Plant Dept.
City, Township or Village where you reside
2. Address, Number and Street
State
Zip Code
Under
3. Predominant Place of Employment
City
Print name of each city where you work for this
25%
40%
60%
80%
100%
employer and circle closest % of total earnings
City
Under
in each.
25%
40%
60%
80%
100%
Enter number of
4. Exemptions
Regular $3000
Additional $3,000 exemption if
Additional $3,000
YOUR WITHHOLDING
Check
}
exemptions
for yourself
exemption
65 or over at end of year
exemption if blind
EXEMPTIONS:
blocks
checked
(See instructions on
which
Enter number of
5. Exemptions
Regular $3000
Additional $3,000 exemption if
Additional $3,000
exemptions
reverse side.)
apply
for your wife (husband)
exemption
65 or over at end of year
exemption if blind
checked
Number
Enter total
Number
EMPLOYEE: File this form with your employer.
6. (a) Exemptions for your
6. (b) Exemptions for your
of line 6
Otherwise
he
must
withhold
CITY
OF
children
other dependents
(a plus b)
GRAYLING income tax from your earnings with-
out exemption.
7. Add the number of exemptions which you have claimed on lines 4,5 and 6 above and write the total
EMPLOYER: keep this certificate with your
I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
records. If the information submitted by the
employee is not believed to be true, correct and
8. Date
Signature
complete. The City Treasurer must be so
20
advised.
❒ RESIDENT
GR W-4
Employee’s Withholding Certificate For City of Grayling
❒ NON-RESIDENT
Income Tax
Employee Identification No.
1. Print Full Name
Social Security No.
Office, Plant Dept.
City, Township or Village where you reside
2. Address, Number and Street
State
Zip Code
3. Predominant Place of Employment
City
Under
Print name of each city where you work for this
25%
40%
60%
80%
100%
employer and circle closest % of total earnings
City
Under
in each.
25%
40%
60%
80%
100%
Enter number of
4. Exemptions
Regular $3000
Additional $3,000 exemption if
Additional $3,000
YOUR WITHHOLDING
Check
}
exemptions
for yourself
exemption
65 or over at end of year
exemption if blind
EXEMPTIONS:
blocks
checked
(See instructions on
which
Enter number of
5. Exemptions
Regular $3000
Additional $3,000 exemption if
Additional $3,000
exemptions
reverse side.)
apply
for your wife (husband)
exemption
65 or over at end of year
exemption if blind
checked
Number
Enter total
Number
6. (a) Exemptions for your
6. (b) Exemptions for your
EMPLOYEE: File this form with your employer.
of line 6
Otherwise
he
must
withhold
CITY
OF
children
other dependents
(a plus b)
GRAYLING income tax from your earnings with-
out exemption.
7. Add the number of exemptions which you have claimed on lines 4,5 and 6 above and write the total
EMPLOYER: keep this certificate with your
I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
records. If the information submitted by the
employee is not believed to be true, correct and
8. Date
Signature
complete. The City Treasurer must be so
advised.
20
❒ RESIDENT
GR W-4
Employee’s Withholding Certificate For City of Grayling
Income Tax
❒ NON-RESIDENT
1. Print Full Name
Social Security No.
Office, Plant Dept.
Employee Identification No.
2. Address, Number and Street
City, Township or Village where you reside
State
Zip Code
3. Predominant Place of Employment
City
Under
25%
40%
60%
80%
100%
Print name of each city where you work for this
employer and circle closest % of total earnings
Under
City
in each.
25%
40%
60%
80%
100%
Enter number of
4. Exemptions
Regular $3000
Additional $3,000 exemption if
Additional $3,000
YOUR WITHHOLDING
Check
}
exemptions
for yourself
exemption
65 or over at end of year
exemption if blind
EXEMPTIONS:
blocks
checked
(See instructions on
which
Enter number of
5. Exemptions
Regular $3000
Additional $3,000 exemption if
Additional $3,000
exemptions
reverse side.)
apply
for your wife (husband)
exemption
65 or over at end of year
exemption if blind
checked
Enter total
Number
Number
6. (b) Exemptions for your
EMPLOYEE: File this form with your employer.
6. (a) Exemptions for your
of line 6
Otherwise
he
must
withhold
CITY
OF
children
other dependents
(a plus b)
GRAYLING income tax from your earnings with-
out exemption.
7. Add the number of exemptions which you have claimed on lines 4,5 and 6 above and write the total
EMPLOYER: keep this certificate with your
I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
records. If the information submitted by the
employee is not believed to be true, correct and
8. Date
Signature
complete. The City Treasurer must be so
advised.
20
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