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Form W-4

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You must complete Form W-4 so the Payroll

Department can calculate the correct amount of tax to withhold from your pay. Federal income tax is

withheld from your wages based on your marital

status and the number of allowances claimed on this form. You may also specify that an additional dollar amount be withheld. You can file a new Form W-4

anytime your tax situation changes and you choose to have more, or less, tax withheld.

W-4 Tax Data

Indicate Indicate Marital Marital Status: Status:

You must call 1-800-***-**** for a new card.

Claim Exemption

NOTE: NOTE:Exempt status is invalid when claiming

additional allowances and/or withholding.

Enter Enter total total number number of of allowances allowances you you are are claiming claiming

[[worksheet worksheet]]

Enter Enter Additional Additional Amount, Amount, if if any, any, you you want want withheld withheld from from each each paycheck paycheck

$

Single or Married, but withhold at higher single

rate

Married

If your last name differs from that shown on your

social security card, check here.

I I claim claim exemption exemption from from withholding withholding for for 2019,2019, and and I I certify certify that that I I meet meet both both of of the the following following conditions conditions for for exemption:exemption: Last year I had a right to a refund of all Federal income tax withheld because I had no tax

liability and

This year I expect a refund of all Federal

income tax withheld because I expect to have

no tax liability.

If you meet both conditions, check 'Exempt' here:

Under Under penalties penalties of of perjury, perjury, I I certify certify that that I I am am entitled entitled to to the the number number of of withholding withholding allowances allowances claimed claimed on on this this certificate certificate or or entitled entitled to to claim claim exempt exempt status. status. I agree that my electronic signature is the

legally binding equivalent to my handwritten

signature. By my electronic signature, I

acknowledge that I have carefully reviewed this

Agreement and understand its contents.

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