State Of Indiana Employee'S Withholding Exemption And County Status Certificate (Form Wh-4)

ADVERTISEMENT

)RUP :+
6WDWH RI ,QGLDQD
6) 
(PSOR\HH V :LWKKROGLQJ ([HPSWLRQ DQG &RXQW\ 6WDWXV &HUWLILFDWH
5HYLVHG 
7KLV IRUP LV IRU WKH HPSOR\HU V UHFRUGV 'R QRW VHQG WKLV IRUP WR WKH 'HSDUWPHQW RI 5HYHQXH
7KH FRPSOHWHG IRUP VKRXOG EH UHWXUQHG WR \RXU HPSOR\HU
)XOO 1DPH
6RFLDO 6HFXULW\ 1XPEHU
+RPH $GGUHVV
&LW\
6WDWH
=LS &RGH
,QGLDQD &RXQW\ RI 5HVLGHQFH DV RI -DQXDU\ 
6HH LQVWUXFWLRQV
,QGLDQD &RXQW\ RI 3ULQFLSDO (PSOR\PHQW DV RI -DQXDU\ 
6HH LQVWUXFWLRQV
+RZ WR &ODLP <RXU :LWKKROGLQJ ([HPSWLRQV
 (DFK WD[SD\HU LV HQWLWOHG WR RQH H[HPSWLRQ ,I \RX ZLVK WR FODLP WKH H[HPSWLRQ HQWHU 

 ,I \RX DUH PDUULHG DQG \RXU VSRXVH GRHV QRW FODLP KLVKHU H[HPSWLRQ \RX PD\ FODLP LW HQWHU 

 <RX DUH DOORZHG RQH  H[HPSWLRQ IRU HDFK GHSHQGHQW (QWHU QXPEHU FODLPHG
 $GGLWLRQDO H[HPSWLRQV DUH
DOORZHG LI D \RX DQGRU \RXU VSRXVH DUH RYHU WKH DJH RI  DQGRU E LI \RX DQGRU \RXU VSRXVH DUH OHJDOO\ EOLQG
&KHFN ER[ HV IRU DGGLWLRQDO H[HPSWLRQV <RX DUH  RU ROGHU
RU EOLQG
6SRXVH LV  RU ROGHU
RU EOLQG
1XPEHU RI ER[HV FKHFNHG
 6HH LQVWUXFWLRQV (QWHU WKH WRWDO QXPEHU RI H[HPSWLRQV

 $GG OLQHV   DQG  (QWHU WKH WRWDO KHUH


 <RX DUH HQWLWOHG WR FODLP DQ DGGLWLRQDO H[HPSWLRQ IRU HDFK TXDOLI\LQJ GHSHQGHQW VHH LQVWUXFWLRQV


 (QWHU WKH DPRXQW RI DGGLWLRQDO VWDWH ZLWKKROGLQJ LI DQ\ \RX ZDQW ZLWKKHOG HDFK SD\ SHULRG

, KHUHE\ GHFODUH WKDW WR WKH EHVW RI P\ NQRZOHGJH WKH DERYH VWDWHPHQWV DUH WUXH
6LJQDWXUH
'DWH

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2