Form W-4 - Employee'Swithholding Allowance Certificate

Form W-4 (2017)

The exceptions don’t apply tosupplemental wages

Nonwageincome. If you havea large amount of

greater than $1,000,000.

nonwage income, such as interest or dividends, consider

making estimated tax payments using Form 1040-ES,

Basicinstructions. If you aren’t exempt, complete the

Estimated Tax for Individuals. Otherwise, you may owe

Purpose.Complete Form W-4so that your employer can

Personal AllowancesWorksheet below.The

additional tax. If you have pension or annuity income, see

withhold the correct federal income tax from your pay.

worksheets on page 2 further adjust your withholding

Pub. 505 to find out if you should adjust your withholding

Consider completing a new Form W-4 each year and

allowances based on itemized deductions, certain

on Form W-4 or W-4P.

when your personal or financial situation changes.

credits, adjustments to income, or two-earners/multiple

jobssituations.

Two earnersor multiple jobs. If you havea working

spouse or more than one job, figure the total number of

Exemption from withholding. If you are exempt,

Complete all worksheets that apply. However, you

allowances you are entitled to claim on all jobs using

complete only lines 1, 2, 3, 4, and 7 and sign the form to

may claim fewer (or zero) allowances.For regular wages,

worksheets from only one Form W-4.Your withholding

validate it.Your exemption for 2017expiresFebruary 15,

withholding must be based on allowances you claimed

usually will be most accurate when all allowances are

2018.SeePub. 505,Tax Withholding and Estimated Tax.

and may not bea flat amount or percentage of wages.

claimed on the Form W-4 for the highest paying job and

zero allowances are claimed on the others.See Pub. 505

Note: If another person can claim you asa dependent on

Head of household.Generally, you can claim head of

for details.

his or her tax return, you can’t claim exemption from

household filing status on your tax return only if you are

Nonresident alien. If you area nonresident alien, see

withholding if your total income exceeds $1,050and

unmarried and pay more than 50% of the costs of

Notice 1392,Supplemental Form W-4 Instructions for

includes more than $350 of unearned income (for

keeping up a home for yourself and your dependent(s)

Nonresident Aliens, before completing this form.

example, interest and dividends).

or other qualifying individuals.See Pub. 501,

Exemptions,Standard Deduction, and Filing Information,

Check your withholding. After your Form W-4 takes

Exceptions. An employee may beable to claim

for information.

effect, use Pub. 505 tosee how theamount you are

exemption from withholding even if the employee isa

having withheld compares to your projected total tax for

Taxcredits.You can take projected taxcredits into

dependent, if the employee:

2017.See Pub. 505, especially if your earnings exceed

account in figuring your allowable number of withholding

• Isage 65 or older,

$130,000 (Single) or $180,000 (Married).

allowances.Credits for child or dependent care expenses

and thechild tax credit may be claimed using the

Future developments. Information about any future

• Is blind, or

Personal AllowancesWorksheet below.SeePub. 505 for

developmentsaffecting Form W-4 (such as legislation

• Will claim adjustments to income; tax credits; or

enacted after we release it) will be posted at

information on converting your other credits into

itemized deductions, on his or her tax return.

withholding allowances.

Personal AllowancesWorksheet (Keep for your records.)

Enter “1” for yourself if no one else can claim you asa dependent

}

•You’re singleand have only one job; or

{

•You’re married, have only one job, and your spouse doesn ’t work; or

Enter “1” if:

•Your wages from asecond job or your spouse’s wages(or the total of both) are $1 ,500 or less.

Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one

job.(Entering “-0-” may help you avoid having too little tax withheld.)

. .

Enter number of dependents(other than your spouse or yourself) you will claim on your tax return .

Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above)

Enter “1” if you haveat least $ 2,000 of child or dependent care expenses for which you plan to claim acredit

(Note: Do not include child support payments.See Pub. 503,Child and Dependent CareExpenses, for details.)

Child TaxCredit (including additional child tax credit).See Pub. 972,Child Tax Credit, for more information.

• If your total income will be less than $ 70,000 ($100,000 if married), enter “2” for each eligible child; then less“1” if you

have two to four

eligible children or less“2” if you have five or more eligible children.

• If your total income will be between $70,000and $84,000 ($100,000and $119,000 if married), enter “1” for each eligible child

▶

Add lines A through Gand enter total here. ( Note: This may be different from the number of exemptions you claim on your tax return.)

{

•

If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions

For accuracy,

and AdjustmentsWorksheet on page 2.

complete all

•

If you are single and have more than one job or are married and you and your spouse both workand the combined

worksheets

$50,000 ($20,000

earnings from all jobs exceed

if married), see the Two-Earners/MultipleJobsWorksheet on page 2

to avoid having too little tax withheld.

that apply.

•

If neither of theabove situationsapplies,stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

W-4

Employee’sWithholding Allowance Certificate

OMBNo. 1545-0074

2017

Form

▶

Whether you are entitled toclaim acertain number of allowancesor exemption from withholding is

Department of the Treasury

subject to reviewby the IRS. Your employer may be requiredtosend acopy of thisform to the IRS.

Internal RevenueService

1 Your first nameand middle initial

Last name

2 Your socialsecurity number

Home address(number and street or rural route)

Single

Married

Married, but withhold at higher Single rate.

Note: If married, but legally separated, or spouse isa nonresident alien, check the “Single” box.

City or town, state, and ZIPcode

4 If your last name differs from that shown on your socialsecurity card, check here.

▶

You must call 1-800-772-1213 for a replacement card.

Total number of allowances you are claiming (from line H above or from theapplicable worksheet on page 2)

Additional amount, if any, you want withheld from each paycheck .

. .

I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption.

• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and

• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.

▶

If you meet both conditions, write “Exempt” here .

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

Employee’ssignature

Date

(This form is not valid unlessyou sign it.)

▶

Employer’s nameand address(Employer:Complete lines 8 and 10 only if sending to the IRS.)

9 Office code (optional)

10 Employer identification number (EIN )

11795

Three W's Inc dba Pioneer Market Fair Harbor; 29 Butler St. West Islip, NY

W-4

For Privacy Act and PaperworkReduction Act Notice,see page 2.

Cat. No. 10220Q

Form

(2017)

Form W-4 - Employee'Swithholding Allowance Certificate - 2017

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