Complete Form W-4 so that your ployer can withhold the correct Federal me tax from your pay. Because your tax siton may change, you may want to refigure r withholding each year. mption from withholding. If you are mpt, complete only lines 1, 2, 3, 4, and 7 and the form to validate it. Your exemption for 3 expires February 16, 2004. See Pub. 505, Withholding and Estimated Tax. e: You cannot claim exemption from withding if: (a) your income exceeds $750 and udes more than $250 of unearned income , interest and dividends) and (b) another son can claim you as a dependent on their return. ic instructions. If you are not exempt, come the Personal Allowances Worksheet w. The worksheets on page 2 adjust your holding allowances based on itemized

may claim fewer (or zero) allowances. Head of household. Generally, you may claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See line E below. Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 919, How Do I Adjust My Tax Withholding? for information on converting your other credits into withholding allowances. Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using

O TPersonal Allowances Worksheet (Keep for your records.) EED N else can claim you as a dependent Enter “1” for yourself ifA Y one M no O UYou are single and have only one job; or Y ●
Enter “1” if:

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spouse or more th number of allowanc on all jobs using wo W-4. Your withholdi rate when all allow Form W-4 for the allowances are claim Nonresident alien. alien, see the Instru completing this Form Check your withho takes effect, use Pu amount you are ha your projected total especially if your (Single) or $175,000 Recent name chan differs from that sh card, call 1-800-772 rity card.

a d yo Enter “1” for your spouse. you lyou may rchoose to enter “-0-” if you are married and have either a working ce But, mploye di orce? Sin more than one job. (Entering ur e may arry oryou avoid ndent? too little tax withheld.) “-0-” help div having e M ith yo w u a dep Enter number of dependents (other than in or lospouse eor yourself) you will claim on your tax return your se ? u Ga nam e on Enter “1” if you will file as head of householdyour your tax return (see conditions under Head of household ang u Ch Enter “1” if you have at least $1,500 of child or dependent care expenses for which you plan to claim a c .)? s, etc .. tal ga (Note: Do not include child support payments. See Pub. 503, pChildinand Dependent Care Expenses, for det ob)? ca i to . ed a j ngestax credit):idends, v or end , di Child Tax Credit (including additionala arted terest or ch child u e st e maj$15,000income (in ($20,000sands $65,000 if married), enter “1” for each eligible child plu ur po ● If your total income will ther ge and $42,000 u or yo ( re be between Wefive eligible ur nonwa 2 additional ifyo have six or more eligible children. come you if you have three to u Yo childrenilorwage in ● If your total income will be betweenfam y andd$80,000?($65,000 and $115,000 if married), enter “1” if you have one or two el r $42,000 e uctions u You e “2” if you have three eligible children, emizif d d have four eligible children, or “4” if you have wed or more eligible children. five t “3” you Your i y of exemptions you claim on your tax s?This may be different from the number ou o u or 4. Add lines A through G and enter total here.rNote: edit stions rm Wr tax c Youto itemize or claim adjustments ue income new Fo se q to u ● If you plan to a and want 6. reduce your withho of the o file 67 oa y . Ton npage may need t 829-3 and Adjustments Worksheet 2. For accuracy, ”. . -800r “Y S t re ur , you ethanEone sjobtornare marriedIRS at 1 and your n 919, both work an complete all ● If you have answ the and you io spouse n more ed your la r call blicat l $35,000, rsee -4 o Two-Earner/Two-Job Worksheet on page 2 to W the ou ca et Pu worksheets from If y all jobs exceed ou fi om ls, g r at hen y y of F detai ulato tax w a cop more that apply. withheld. For g Calc xtra r for e in ing. loye hhold hhold re p ● IfSneither m the aboveksituations applies, tstopithere and enter the number from line H on he W ur wit e you of e yo use
, or hec e to c lding? e tim ithho sit . s Cut th and givex W W-4 to youre employer. Keep the top part forry your records. Now i here just My Ta Form he IRS web u Treas nt of the I Ad ment ervice uals o Depart Revenue S w Do Ho ivid al Intern v/ind .gov .irs .irs.go www ww -2003) rd w a (Rev.7 47P tin Bo n 213

● You are married, have only one job, and your spouse does not work; or -4 ● Your wages from a second job W your spouse’s wages (or the total of both) are $1,000 or less d Form or e

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Employee’s Withholding Allowance Certificate
Reduction Act Notice, see page 2.
10 atio ber 1 Public g Num C a ta lo

artment of the Treasury nal Revenue Service

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