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NC-4

Employee’s Withholding

Web

Allowance Certificate

11-15

PURPOSE - Complete Form NC-4, Employee’s Withholding Allowance

HEAD OF HOUSEHOLD - Generally you may claim head of household

Certificate, so that your employer can withhold the correct amount of

status on your tax return only if you are unmarried and pay more than

State income tax from your pay. If you do not provide an NC-4 to your

50% of the costs of keeping up a home for yourself and your dependent(s)

employer, your employer is required to withhold based on single with

or other qualifying individuals. Note: “Head of Household” for State tax

zero allowances.

purposes is the same as for federal tax purposes.

FORM NC-4 EZ - You may use this form if you intend to claim either:

exempt status, or the N.C. standard deduction and no tax credits or only

QUALIFYING WIDOW(ER) - You may claim qualifying widow(er) status

the credit for children.

only if your spouse died in either of the two preceding tax years and you

meet the following requirements:

FORM NC-4 NRA - If you are a nonresident alien you must use Form NC-4

NRA.

Your home is maintained as the main household of a child or stepchild

FORM NC-4 BASIC INSTRUCTIONS - Complete the Allowance

for whom you can claim a federal exemption; and

Worksheet. The worksheet will help you figure the number of withholding

You were entitled to file a joint return with your spouse in the year of

allowances you are entitled to claim.

The worksheet is provided for

your spouse’s death.

employees to adjust their withholding allowances based on N.C. itemized

deductions, federal adjustments to income, N.C. additions to federal

adjusted gross income, N.C. deductions from federal adjusted gross

MARRIED TAXPAYERS - For married taxpayers, both spouses must agree

income, and N.C. tax credits. However, you may claim fewer allowances

as to whether they will each complete the Allowance Worksheet based on

if you wish to increase the tax withheld during the year. If your withholding

married filing jointly or married filing separately.

allowances decrease, you must file a new NC-4 with your employer within

10 days after the change occurs. Exception: When an individual ceases to

be head of household after maintaining the household for the major portion

•

For married taxpayers completing the Allowance Worksheet based

of the year, a new NC-4 is not required until the next year.

on married filing jointly, you will consider the sum of both spouses

incomes, adjustments, additions, deductions, and credits on the

TWO OR MORE JOBS - If you have more than one job, figure the total

Allowance Worksheet to determine the number of allowances.

number of allowances you are entitled to claim on all jobs using one Form

NC-4 Allowance Worksheet. Your withholding will usually be most accurate

when all allowances are claimed on the NC-4 filed for the higher paying job

•

For married taxpayers completing the worksheet on the basis of

and zero allowances are claimed for the other. You should also refer to the

married filing separately, each spouse will consider only his or her

Multiple Jobs Table to determine the additional amount to be withheld on

portion of income, adjustments, additions, deductions, and credits on

line 2 of Form NC-4 (See Allowance Worksheet).

the Allowance Worksheet to determine the number of allowances.

NONWAGE INCOME - If you have a large amount of nonwage income,

such as interest or dividends, you should consider making estimated tax

All NC-4 forms are subject to review by the North Carolina Department

payments using Form NC-40 to avoid underpayment of estimated tax

of Revenue. Your employer may be required to send this form to the

interest. Form NC-40 is available on our website at under

individual income tax forms.

North Carolina Department of Revenue.

CAUTION: If you furnish an employer with an Employee’s Withholding Allowance Certificate that contains information which has no

reasonable basis and results in a lesser amount of tax being withheld than would have been withheld had you furnished reasonable

information, you are subject to a penalty of 50% of the amount not properly withheld.



Cut here and give this certificate to your employer. Keep the top portion for your records.

NC-4

Employee’s Withholding Allowance Certificate

Web

North Carolina Department of Revenue

10-14

1. Total number of allowances you are claiming

(Enter zero (0), or the number of allowances from Page 2, line 16 of the NC-4 Allowance Worksheet)

Additional amount, if any, withheld from each pay period (Enter whole dollars)

Social Security Number

Marital Status

Single

Head of Household

Married or Qualifying Widow(er)

First Name

M.I.

Last Name

(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)

Address

County

(Enter first five letters)

City

State

Zip Code (5 Digit)

Country (If not U.S.)

Employee’s Signature

Date

I certify, under penalties provided by law, that I am entitled to the number of withholding allowances claimed on line 1 above.

Form Nc-4 - Employee'S Withholding Allowance Certificate, Nc-4p Allowance Worksheet 2015

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