W-4 Form | Single Source Systems Inc.

W-4 For Employees

Step 1: Enter Personal Information

First name and middle initial(Required)

Last name(Required)

Social security number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Marital Status(Required)

Single or Married filing separately

Married filing jointly

Head of house hold (Check only if you're unmarried and i,ay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5 See page 2 for more information on each step, who can claim exemption from withholding, other details, and. privacy.

Step 2: Multiple Jobs or Spouse Works

Two Jobs

If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job.

Step 3: Claim Dependents 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

Total Above Values

Step 4 (optional): Other Adjustments

Other income (not from jobs). if you want tax withheld for other income you (optional): expect this year that won't have withtolding, enter the amount of other income here. Other This may include interest, dividends, and retirement income

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 the result here

Extra withholding. Enter any additional tax you want withheld each pay period

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.(Required)

Date(Required)