Part 86, page 70

Transcript

The scan is the source; the transcript is machine-generated from it.

1. NUMBER OF EXEMPTIONS.—Do not claim more than the correct number of exemptions. However, if I expect to owe more income tax than will be withheld, a smaller [number] of exemptions may be claimed or you may enter into an agreement with your employer to have additional amounts withheld. Note this if you have more than one employer, or if both husband and wife are employed.

2. ITEMIZED DEDUCTIONS.—See Schedule A (Form W-4) for instructions on claiming additional allowances based on large itemized deductions.

3. CHANGES IN EXEMPTIONS.—You may file a new certificate at any time if the number of your exemptions INCREASES. You must file a new certificate within 10 days if the number of exemptions previously claimed by you DECREASES because: (a) Your wife (or husband) for whom you have been claiming exemption is divorced or legally separated, or claims her (or his) own exemption on a separate certificate. (b) The support of a dependent for whom you claimed exemption is taken over by someone else, so that you no longer expect to furnish more than half the support for the year. (c) You find that a dependent for whom you claimed exemption will receive $600 or more of income of his own during the year (except your child who is a student or who is under 19 years of age).

The death of a wife or a dependent, does not affect your withholding until the next year, but requires the filing of a new certificate. If pos-

sible, file a new certificate by December 1 of the year in which the death occurs.

For further information [co]nsult your local District Director of Internal Revenue or your employer.

4. DEPENDENTS.—To qualify as your dependent (line 4 on other side), a person (a) must receive more than one-half of his or her support from you for the year, and (b) must have less than $600 gross income during the year (except your child who is a student or who is under 19 years of age), and (c) must not be claimed as an exemption by such person's husband or wife, and (d) must be a citizen or resident of the United States or a resident of Canada, Mexico, the Republic of Panama or the Canal Zone (this does not apply to an alien child legally adopted by and living with a United States citizen abroad), and (e) must (1) have your home as his principal residence and be a member of your household for the entire year, or (2) be related to you as follows: Your son or daughter (including legally adopted children), grandchild, stepson, stepdaughter, son-in-law, or daughter-in-law; Your father, mother, grandparent, stepfather, stepmother, father-in-law, or mother-in-law; Your brother, sister, stepbrother, stepsister, half brother, half sister, brother-in-law, or sister-in-law; Your uncle, aunt, nephew, or niece (but only if related by blood).

5. PENALTIES.—Penalties are imposed for willfully supplying false information or willful failure to supply information which would reduce the withholding exemptions.

U.S. GOVERNMENT PRINTING OFFICE o46—16—70061-1

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1. IF YOU FAIL to file this certificate with your employer, he must withhold Virginia income tax from your wages without exemption. If an employer believes that an employee is claiming an excessive amount of exemptions, [he] will advise the Department of Taxation.

2. AMOUNT OF EXEMPTIONS.—Do not claim more than the correct amount of exemptions. However, if you expect to owe more income tax for the taxable year than will be withheld if you claim every exemption to which you are entitled, you may increase the withholding by claiming a smaller amount of exemptions or you may enter into an agreement with your employer to have additional amounts withheld.

3. EMPLOYEES WITH TWO OR MORE EMPLOYERS.—If you have more than one employer and wish to increase your withholding to an amount nearer your correct income tax you should claim a smaller amount or no exemptions on each Form Va.—4 filed with all employers other than your principal employer.

4. CHANGES IN EXEMPTIONS.—You may file a new certificate at any time if the amount of your exemptions INCREASES. You must file a new certificate within 10 days if the amount of exemptions previously claimed by you DECREASES for any of the following reasons: (a) Your wife (or husband) for whom you have been claiming exemption is divorced or legally separated, or claims her (or his) own exemption on a separate certificate. (b) The support of a dependent for whom you claimed exemption is

taken over by someone else, so that you no longer expect to furnish more than half the support for the year. You find that a dependent for whom you claimed exemption will receive $600 or more of income [of] his own during the taxable year.

OTHER DECREASES [in] exemption, such as the death of a wife or a dependent, do not affect your withholding until the next year, but require the filing of a new certificate by December 1 of the year in which they occur.

5. DEPENDENTS.—Do not claim any dependent in Line 3 (on other side) unless he or she meets all four of the following tests: (a) He or she is receiving over one-half of his or her support from you for the taxable year, and (b) he or she is "closely related" to you, and (c) he or she will not have as much as $600 gross income of his or her own during the taxable year (if a son, daughter, stepson, or stepdaughter is a full time student at an educational institution, this limitation does not apply), and (d) if married, her or his exemption is not claimed by her husband or his wife. "Closely related" means your children (including stepchildren and legally adopted children) and grandchildren; your parents and grandparents; your brothers and sisters; your immediate "in-laws" (mother, father-, son-, daughter-, brother-, sister-in-law); your blood related uncles, aunts, nieces, and nephews.

If you are a married person, do not make any entry whatsoever in Line 4 (on other side).

6. PENALTIES.—Penalties are imposed for willfully supplying false information or willful failure to supply information which would reduce the withholding exemption.

EMPLOYER.—KEEP THIS CERTIFICATE WITH YOUR RECORDS.

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DB Cooper-37914