OMB No.

1545-0074
Form W - 4 Employee?s W i t h h o l d i n g Certificate
(Rev. December 2020) > C o m p l e t e F o r m W - 4 s o t h a t y o u r e m p l o y e r can w i t h h o l d t h e c o r r e c t f e d e r a l i n c o m e t a x f r o m y o u r pay.
Department of the Treasury > Give Form W-4 to your employer.
Internal Revenue Service > Y o u r w i t h h o l d i n gis s u b j e c t t o r e v i e w b y t h e IRS.

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Enter > Does your n a m e
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c a r d ? if not, to e n s u r e y o u get
I n f o r m a t i o n C io r tt o wy n , s t a t e , a n d Z I P c o d e c r e d i t for y o u r e a r i n g s , c o n t a c t
SSA at 800-772-1213 or go to
WWW. SSB.gOV.
(©) ( S o ir Married
n filingseparately
g l e
( 1 Marriedfiling jointly or Qualitying widow(er}
( 7 ) Heado f household (Checkonlyi f you're unmarriedandpay morethanhalf thecosts ofkeeping up ahomef o r yourselfand a qualifyingindividual.)

C o m p l e t e S t e p s 2~4 O N L Y i f t h e y a p p l y t o you; o t h e r w i s e , s k i p t o Step 5. See p a g e 2 for m o r e infogmation on e a c h step, w h o can

claim e x e m p t i o n f r o m withholding, when to use t h e estimator at www.irs.gov/W4App, and privacy.

S t e p 2: C o m p l e t e this step if you (1) hold m o r e than o n e j o b at a time, o r (2) are married filing jointly and your s p o u s e
Multiple Jobs also w o r k s . The correct a m o u n t of withholding d e p e n d s on i n c o m e earned f r o m all of these jobs.
or Spouse Do only one of the following.
Works (a) U s e t h e estimator at w w w . i r s . g o v / W 4 A p p f o r m o s t accurate withholding for this step (and S t e p s 3 - 4 ) ; o r

(b) U s e the M u l t i p l e J o b s W o r k s h e e t o n p a g e 3 a n d e n t e r t h e result in S t e p 4(c) b e l o w f o r r o u g h l y a c c u r a t e w i t h h o l d i n g ; o r

(c) If there are only t w o j o b s total, you may check this box. Do t h e s a m e on Form W - 4 for t h e o t h e r job. This option
is accurate for jobs with similar pay; otherwise, m o r e tax than necessary may be w i t h h e l d . .
. . . »

T I P : To be accurate, s u b m i t a 2021 Form W - 4 for all other jobs. If you (or y o u r spouse) have s e l f - e m p l o y m e n t
income, including a s an independent contractor, use t h e estimator.

C o m p l e t e S t e p s 3 - 4 { b ) on F o r m W - 4 f o r o n l y O N E of t h e s e j o b s . Leave t h o s e steps blank for t h e other j o b s . (Your w i t h h o l d i n g will

be m o s t a c c u r a t e i f you c o m p l e t e Steps 3-4(b) on the Form W - 4 for t h e highest paying job.)

S t e p 3: if your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Claim .

Dependents Multiply the number of qualifying children under age 17 by $2,000 > $

Multiply the number of other dependents by$500 . . . . hm

$

A d d t h e a m o u n t s a b o v e a n d enter t h e t o t a l here

Step 4 (a) Other income (not from jobs). If you want tax withheld for o t h e rincome you expect
(optional): this year that won't have withholding, enter the amount of other Income here. This may
Other include interest, dividends, and retirement income . r e
Adjustments
(b) D e d u c t i o n s . If y o u e x p e c t to claim d e d u c t i o n s other than t h e s t a n d a r d deduction

a n d w a n t t o reduce y o u rw i t h h o l e l i n g , use t h e Deductions W o r k s h e e t onp a g e $3 and

enter t h e result here . hoe

(c) E x t r a w i t h h o l d i n g . Enter a n y a d d i t i o n a l tax y o u w a n t withheld e a c h p a y p e r l o d

EXEMPT
Informational purposes only. Done in good faith. Given for Patent Rights. All rights reserved. Authorized Representative.

By:
Y E m p l o y e e ' s s i g n a t u r e (This f o r m Is n o t valid unless you sign it.)

First d a t e o f Employer identification

Employers| Employer's name and address
employment number (EIN)
Only

For P r i vAac tca nyd Paperwork Reduction A c t Notice, see page 3. Cat, No. 102200 Form W - 4 (2021)