Form Ar4ec - Employee'S Withholding Exemption Certificate
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1Arkansas Individual Income Tax Section
For additional information consult your employer or:
Withholding Branch
P. O. Box 8055
Little Rock, Arkansas 72203-8055
STATE OF ARKANSAS
AR4EC
Employee’s Withholding Exemption Certificate
Print Full Name ____________________________________________________ Social Security Number ____________________________________
Print Home Address ________________________________________________ City ____________________________ State _____ Zip ________
How to Claim Your Withholding
Number of Exemptions
Claimed
Instructions on the Reverse Side
Employee:
File this form with
1.
CHECK ONE OF THE FOLLOWING FOR EXEMPTIONS CLAIMED
your employer.
(a) You claim yourself. (Enter one exemption) ...................................................................................
Otherwise, your
(b) You claim yourself and your spouse. (Enter two exemptions) ........................................................
employer must
(c) Head of Household, and you claim yourself. (Enter two exemptions) ............................................
withhold state
income tax from
2.
NUMBER OF CHILDREN or DEPENDENTS. (Enter one exemption per dependent) .........................
your wages without
exemptions or
3.
TOTAL EXEMPTIONS. (Add Lines 1a, b, c and 2)
dependents.
If no exemptions or dependents are claimed, enter zero ....................................................................
Employer:
4.
Additional amount, if any you want deducted from each paycheck. (Enter dollar amount) ....................
Keep this certificate
with your records.
5.
I qualify for the low income tax rates. (See reverse for details) ............................................................
Yes
No
Please check filing status:
Single
Married Filing Jointly
Head of Household
I certify that the number of exemptions and dependents claimed on this certificate does not exceed the number to which I am entitled.
Signature: _______________________________________________________________________________________ Date: _________________
Instructions for completing the
Employee’s Withholding Exemption Certificate
1.
TYPES OF INCOME - This form can be used for withholding on
4.
CHANGES IN EXEMPTIONS OR DEPENDENTS – You may
all types of income including pensions and annuities.
file a new certificate at any time if the number of exemptions or depen-
dents INCREASES. You must file a new certificate within 10 days if the
2.
NUMBER OF EXEMPTIONS – (Husband and/or Wife) Do not
number of exemptions or dependents previously claimed by you DE-
claim more than the correct number of exemptions. However, if you ex-
CREASES for any of the following reasons:
pect to owe more income tax for the year, you may increase your with-
(a) Your spouse for whom you have been claiming an
holding by claiming a smaller number of exemptions and/or dependents,
exemption is divorced or legally separated, or claims
or you may enter into an agreement with your employer to have addi-
his or her own exemption on a separate certificate, or
tional amounts withheld. This is especially important if you have more
(b) The support of a dependent for whom you claimed
than one employer, or if both husband and wife are employed.
an exemption is expected to be less than half of the
total support for the year.
3.
DEPENDENTS – To qualify as your dependent (line 1 on the re-
OTHER DECREASES in exemptions or dependents, such as the death
verse side), a person must (a) receive more than 1/2 of their support
of a spouse or a dependent, do not affect your withholding until next
from you for the year, (b) not be claimed as a dependent by such person’s
year, but require the filing of a new certificate by December 1, of the year
spouse, (c) be a citizen or resident of the United States, and (d) have
in which they occur.
your home as their principle residence and be a member of your house-
5.
hold for the entire year or be related to you as follows: son, daughter,
Claim additional amounts of withholding tax if desired. This will ap-
grandchild, stepson, stepdaughter, son-in-law or daughter-in-law; Your
ply most often when you have income other than wages.
father, mother, grandparent, stepfather, stepmother, father-in-law or
6.
mother-in-law; Your brother, sister, stepbrother, stepsister, half brother,
You qualify for the low income tax rates if your total income from
half sister, brother-in-law or sister-in-law; Your uncle, aunt, nephew or
all sources are as shown below:
niece (but only if related by blood).
(a) Single
$7,800
to $11,400
(b) Married filing jointly $15,500
to $16,200
(c) Head of Household
$12,100
to $16,200
AR4EC (R 11/05)
107
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