Employee’s Withholding Certificate

Employee’s Withholding Certificate
Department of the Treasury Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS.

For Instructions: Please review the W-4 form attached to the Town of Burgaw website
Step 1:
(a) First name and middle initial
Last name
(b) Social security number
Enter Personal Information
Address
City or town, state, and ZIP code
(c)

Single or Married filing separatelyMarried filing jointly or Qualifying surviving spouseHead of household Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual
Claim Dependent and Other Credits
If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500 .....
Add the amounts above for qualifying children and other dependents. You may add to

this the amount of any other credits. Enter the total here
3
Step 4 (optional) Other Adjustments:
If you want tax withheld for other income you

expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.
4(a)
(b) Deductions. If you expect to claim deductions other than the standard deduction and

want to reduce your withholding, use the Deductions Worksheet on page 3 and enter below.
4(b)
(c)Extra withholding. Enter any additional tax you want withheld each pay period .
4(c)
Step 5: Sign Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Employee’s Withholding Certificate

Step 1:

Enter Personal Information

Claim Dependent and Other Credits

Step 4 (optional) Other Adjustments:

Step 5: Sign Here