Looking for a Puerto Rico Department Of Treasury Forms And Templates? Download it for free!

Form 499 R- 4B

Commonwealth of Puerto Rico

Rev. 12.04

Department of the Treasury

DETERMINATION OF ALLOWANCE BASED

ON DEDUCTIONS UNDER THE OPTIONAL METHOD

Employee's name

Social security number

Spouse's social security number

Employee's home address

FOR EMPLOYEE'S USE ONLY

;

Alternative 1

Alternative 2

Select one alternative

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Optional Standard Deduction ..................................................................

(1)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Estimated Itemized Deductions:

Home mortgage interest .......................................................................

(2a)

License plates for automobiles used for personal purposes .....................

(2b)

Child care expenses ............................................................................

(2c)

Expenses incurred in the care of elderly persons ...............................

(2d)

Rent paid ............................................................................................

(2e)

Property tax on principal residence .......................................................

(2f)

Casualty loss on your principal residence................................................

(2g)

Medical expenses ...............................................................................

(2h)

Charitable contributions .......................................................................

(2i)

Loss of personal property as a result of certain casualties .......................

(2j)

Windmills expenses ............................................................................

(2k)

Expenses incurred in technological assistance equipment for

handicapped persons, and for persons with specialized treatment or

chronic disease ...............................................................................

(2 l)

Dependent's education expenses .........................................................

(2m)

Solar equipment expenses ...................................................................

(2n)

Interest paid on students loans at university level ................................

(2o)

Contributions to the Fund for Services Against Remediable Catastrophic

Diseases ............................................................................................

(2p)

Estimated Additional Deductions:

Contributions to Individual Retirement Accounts ..................................

(3a)

Contributions to governmental pension or retirement systems .............

(3b)

Deduction when both spouses work.....................................................

(3c)

Veterans .............................................................................................

(3d)

Ordinary and necessary expenses........................................................

(3e)

Automobile loan interest (up to $1,200).................................................

(3f)

Young people who work .......................................................................

(3g)

Educational Contributions Accounts ...................................................

(3h)

Acquisition and installation of a personal computer used by dependents ..

(3i)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Total Estimated Itemized and Additional Deductions ...............................

(4)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Total Optional Standard Deduction and Estimated Additional Deductions ...........

(5)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Number of Allowances under Alternative 1 (Line 4 divided by $500) ..........

(6)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Number of Allowances under Alternative 2 (Line 5 divided by $500) ..........

(7)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Allowances that you want to claim under Alternative 1 (From line 6) ............

(8)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

Allowances that you want to claim under Alternative 2 (From line 7) ............

(9)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1

OATH

I declare under the penalty of perjury that I have examined this form, and to the best of my knowledge, the information contained

herein is true, correct and complete.

___________________________________________

____________________________

Employee's signature

Date

FOR EMPLOYER'S USE ONLY

(i)

Number of Allowances (Under the Percentage Method) (Line 8 or 9) .................................................

(ii)

Number of Allowances (Under the Wage Bracket Method) (Line 8 or 9 multiplied by $500 and

divided by $1,600) .........................................................................................................................

Conservation Period: Six (6) years

Form 499 R-4b - Determination Of Allowance Based On Deductions - Puerto Rico Department Of The Treasury

Related Articles

Related forms

Related Categories