Employee'S Withholding Allowance Certificate Template - California
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4Clear Form
This form can be used to manually compute your
withholding allowances, or you can electronically
compute them at
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 2013
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 FORM 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
allowances you claim on your Form W-4 withholding
Income Tax (PIT) withholding purposes only. The DE 4 is
allowance certificate for your state income tax withholding,
used to compute the amount of taxes to be withheld from your
you may be significantly underwithheld. This is particularly true
wages, by your employer, to accurately reflect your state tax
if your household income is derived from more than one source.
withholding obligation.
CHECK YOUR WITHHOLDING: After your Form W-4 and/or
You should complete this form if either:
DE 4 takes effect, compare the state income tax withheld with
your estimated total annual tax. For state withholding, use
(1) You claim a different marital status, number of regular
the worksheets on this form, and for federal withholding use
allowances, or different additional dollar amount to be withheld for
the Internal Revenue Service (IRS) Publication 919 or federal
California PIT withholding than you claim for federal income tax
withholding calculations.
withholding or,
EXEMPTION FROM WITHHOLDING: If you wish to claim
(2) You claim additional allowances for estimated deductions.
exempt, complete the federal Form W-4. You may claim
exempt from withholding California income tax if you did not
THIS FORM WILL NOT CHANGE YOUR FEDERAL
owe any federal income tax last year and you do not expect
WITHHOLDING ALLOWANCES.
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, number
continue to qualify for the exempt filing status, a new Form W-4
of regular allowances, and/or the same additional dollar amount
designating EXEMPT must be submitted before February 15.
to be withheld for state and federal purposes. However, federal
If you are not having federal income tax withheld this year but
tax brackets and withholding methods do not reflect state PIT
expect to have a tax liability next year, the law requires you to
withholding tables. If you rely on the number of withholding
give your employer a new Form W-4 by December 1.
DE 4 Rev. 41 (1-13) (INTERNET)
Page 1 of 4
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