Employee'S Withholding Allowance Certificate - La Sierra University
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4This form can be used to manually
compute your withholding allowances, or
you can electronically compute them at
(Microsoft
Excel required).
EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE
Type or Print Your Full Name
Your Social Security Number
Home Address (Number and Street or Rural Route)
Filing Status Withholding Allowances
SINGLE or MARRIED (with two or more incomes)
City, State, and ZIP Code
MARRIED (one income)
HEAD OF HOUSEHOLD
1. Number of allowances for Regular Withholding Allowances, Worksheet A
Number of allowances from the Estimated Deductions, Worksheet B
Total Number of Allowances (A + B) when using the California
Withholding Schedules for 2010
OR
2. Additional amount of state income tax to be withheld each pay period (if employer agrees), Worksheet C
OR
3. I certify under penalty of perjury that I am not subject to California withholding. I meet the conditions set forth under
the Service Member Civil Relief Act, as amended by the Military Spouses Residency Relief Act.
(Check box here)
Under the penalties of perjury, I certify that the number of withholding allowances claimed on this certificate does not exceed
the number to which I am entitled or, if claiming exemption from withholding, that I am entitled to claim the exempt status.
Signature
Date
Employer’s Name and Address
California Employer Account Number
cut here
Give the top portion of this page to your employer and keep the remainder for your records.
YOUR CALIFORNIA PERSONAL INCOME TAX MAY BE UNDERWITHHELD IF YOU DO NOT FILE THIS DE 4 FORM
IF YOU RELY ON THE FEDERAL W-4 FOR YOUR CALIFORNIA WITHHOLDING ALLOWANCES, YOUR CALIFORNIA STATE
PERSONAL INCOME TAX MAY BE UNDERWITHHELD AND YOU MAY OWE MONEY AT THE END OF THE YEAR.
PURPOSE: This certificate, DE 4, is for California personal
on the number of withholding allowances you claim on
income tax withholding purposes only. The DE 4 is used to
your Form W-4 withholding allowance certificate for your
state income tax withholding, you may be significantly
compute the amount of taxes to be withheld from your wages,
by your employer, to accurately reflect your state tax withholding
underwithheld. This is particularly true if your household
obligation.
income is derived from more than one source.
You should complete this form if either:
CHECK YOUR WITHHOLDING: After your W-4 and/or
DE 4 takes effect, compare the state income tax withheld
(1) You claim a different marital status, number of regular
with your estimated total annual tax. For state withholding,
allowances, or different additional dollar amount to be withheld
use the worksheets on this form, and for federal withholding
for California personal income tax withholding than you claim
use the Internal Revenue Service (IRS) Publication 919 or
for federal income tax withholding or,
federal withholding calculations.
(2) You claim additional allowances for estimated deductions.
EXEMPTION FROM WITHHOLDING: If you wish to claim
exempt, complete the federal Form W-4. You may claim
THIS FORM WILL NOT CHANGE YOUR FEDERAL
exempt from withholding California income tax if you did not
WITHHOLDING ALLOWANCES.
owe any federal income tax last year and you do not expect
to owe any federal income tax this year. The exemption
The federal Form W-4 is applicable for California withholding
automatically expires on February 15 of the next year. If you
purposes if you wish to claim the same marital status,
continue to qualify for the exempt filing status, a new Form
number of regular allowances, and/or the same additional
W-4 designating EXEMPT must be submitted before February
dollar amount to be withheld for state and federal purposes.
15. If you are not having federal income tax withheld this
However, federal tax brackets and withholding methods do not
year but expect to have a tax liability next year, the law
reflect state personal income tax withholding tables. If you rely
requires you to give your employer a new Form W-4 by
December 1.
DE 4 Rev. 37 (1-10) (INTERNET)
Page 1 of 4
CU
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