Form W-4: Employee's Withholding Certificate

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Provide your first and last name as they appear on your social security card.

First name

Last name

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What is your current address?

Address(1)

Address(2)

City

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Zip

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Social Security Number (enter as xxx-xx-xxxx)

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Select the one that best reflects your federal tax filing status.

Single or Married filing separately

Married filing jointly (or Qualifying widow(er))

Head of Household (Check only if you are unmarried and pay more than half of the costs of keeping up a home for yourself and a qualifying individual)

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STEP 2: MULTIPLE JOBS OR SPOUSE WORKS

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

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Select only one of the following:

Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

Use the Multiple Jobs Worksheet on page 3 of the Form W-4 and enter the result in Step 4(c) below for roughly accurate withholding; or

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 accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld.

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STEP 3: CLAIM DEPENDENTS

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If your income will be $200,000 or less ($400,000 or less if married filing jointly), please select and complete the calculation for all of the following that apply:

Multiply the number of qualifying children under age 17 by $2,000

Multiply the number of other dependents by $500

Add the amounts above and enter the total here:

Does not apply.

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STEP 4 (OPTIONAL): OTHER ADJUSTMENTS

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Select and enter the respective amounts for all that apply.

Other income (not from jobs). 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.

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 of the Form W-4 and enter the result here.

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

None of the above apply.

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Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Clear

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Employers Only Section

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Type question here

Employer Name

Employer Address, City, State, Zip Code

Employee First Date of Employment

Employer Identification Number (EIN)