Fillable Form Ct-W4 - Employee'S Withholding Certificate printable pdf download

State of Connecticut

FORM CT-W4

Department of Revenue Services

Effective July 1, 1998

Purpose. Complete Form CT-W4 so that your employer can withhold the correct

To Avoid Underwithholding. You could be underwithheld if any of the following

apply:

amount of Connecticut income tax from your pay. Underwithholding may result in

you have more than one job;

interest charges at the rate of 1% (.01) per month or fraction thereof. If you are

you qualify under the Special Rules For Certain Married

newly hired, your employer must, within 20 days, send a copy of this form to the

Individuals, and do not use the supplemental table;

Department of Labor pursuant to Conn. Gen. Stat. §31-254b.

you have substantial nonwage income;

you were not employed during the first 6 months of 1998; or

General Instructions. Complete the certificate below, sign it, and return it to

your income increased substantially during the last 6 months

your employer. Refer to IP 92(9.5), Is My Connecticut Withholding Correct? , to

of 1998.

check the amount of your Connecticut income tax withholding. Additional

If you could be underwithheld, you should consider adjusting your withholding or

information is provided on back of this form.

making estimated payments on Form CT-1040ES, Estimated Connecticut Income

Exemption From Withholding. Read Line 4 of the certificate below to see if

Tax Payment Coupon for Individuals . You may also wish to select Filing Status “D” to

elect the highest level of withholding.

you can claim exempt status. If you are exempt, complete Line 4, but do not

Nonresident Employees who work partly within and partly outside of Connecticut,

complete Lines 2 and 3. Sign the form and return it to your employer. Connecticut

income tax will not be withheld from your pay. However, the Department of Revenue

see information on back of this form.

Services may review any Form CT-W4 claiming exemption from withholding.

Filing Status Worksheet

Check one box for filing status and enter letter on Line 1 below:

You are single; or

You are married and you are filing separately; or

You are married filing jointly, both you and your spouse work, and your combined income is $100,500 or less.

(Refer to Special Rules For Certain Married Individuals on Page 2.)

You will file as a head of household on your federal tax return.

You are married filing jointly and your spouse is not employed.

You are married filing jointly, have a working spouse, and your combined income is more than $100,500; or

You have a significant nonwage income, and wish to avoid having too little tax withheld; or

You are a nonresident and you have substantial other income.

You are exempt because you qualify on Line 4 below.

000COMPLETE SCHEDULE BELOW - Please Print Clearly000

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CUT HERE AND GIVE THE CERTIFICATE TO YOUR EMPLOYER. KEEP THE TOP PORTION FOR YOUR RECORDS

EMPLOYEE’S WITHHOLDING OR

State of Connecticut

CT-W4

FORM

EXEMPTION CERTIFICATE

Department of Revenue Services

1. Filing Status (Enter letter from box checked above) .................................................................................................. 1_____________________

2. Additional withholding amount per pay period ............................................................................................................ 2. ____________________

3. Reductional withholding amount per pay period ......................................................................................................... 3. ____________________

4. I claim exemption from withholding and I certify that I meet the following condition for exemption:

This year I expect a refund of ALL Connecticut income tax withheld because I expect to have NO Connecticut income tax liability.

If you meet the above condition, check here to claim exemption from withholding ................................... 4.

FIRST NAME

LAST NAME

YOUR SOCIAL SECURITY NUMBER

HOME ADDRESS

CITY/TOWN

STATE

ZIP CODE

DATE

EMPLOYEE’S SIGNATURE