Scribd Logo
Upload

Welcome to Scribd!

  • 66 views

    IBMI US State Tax Withholding Form

    Uploaded by

    Dillipsahu14
    The document is a state tax form that collects personal and work address information from an employee such as name, social security number, home and work addresses and county. It also collects information to calculate the number of tax allowances and determines an employee's marital status and total allowances. The employee must sign and date the form under penalty of perjury to certify the number of withholding allowances claimed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    IBMI US State Tax Withholding Form

    Uploaded by

    Dillipsahu14
    66 views1 page
    The document is a state tax form that collects personal and work address information from an employee such as name, social security number, home and work addresses and county. It also collects information to calculate the number of tax allowances and determines an employee's marital status and total allowances. The employee must sign and date the form under penalty of perjury to certify the number of withholding allowances claimed.

    Original Description:

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is a state tax form that collects personal and work address information from an employee such as name, social security number, home and work addresses and county. It also collects information to calculate the number of tax allowances and determines an employee's marital status and total allowances. The employee must sign and date the form under penalty of perjury to certify the number of withholding allowances claimed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    66 views1 page

    IBMI US State Tax Withholding Form

    Uploaded by

    Dillipsahu14
    The document is a state tax form that collects personal and work address information from an employee such as name, social security number, home and work addresses and county. It also collects information to calculate the number of tax allowances and determines an employee's marital status and total allowances. The employee must sign and date the form under penalty of perjury to certify the number of withholding allowances claimed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    State Tax Form

    Fax completed form to: 919-543-4747

    COMPLETE BOTH PERSONAL AND WORK ADDRESS SECTIONS


    Employee First Name: ____________________________________ Last Name: ______________________________________

    Serial Number: _________________ Social Security Number : _________________________

    Home Address: _________________________________________________ City: __________________________________

    County*___________________________________ State _____________________________ Zip Code : _________________


    ===================================================================================================
    Report all changes in work location within 10 days.

    Work Location Address: _________________________________________ City: __________________________________

    County*______________________________________ State ___________________________ Zip Code ________________

    If your work location is in one of the states listed below that do no have state income tax on wage payments, mark your
    work state with an “X”, sign and return this form. No election is required in the following section.

    ___ Alaska ___ Florida ___ Nevada,


    ___ New Hampshire ___ South Dakota ___ Tennessee
    ___ Texas ___ Washington ___ Wyoming.

    Use the following worksheet to calculate the number of tax allowances you should select.
    (Please note: Only your spouse or dependents with a US Taxpayer ID are eligible when filing a US tax return.)

    1. Personal allowance(s) enter “1” for you …................................................................................................................ ____


    2. If married, enter “1” for your „eligible‟ spouse if not separately claimed by spouse …………………………………… ____
    3. Allowances for dependents (enter the total number of „eligible‟ dependents other than your spouse) ....………….. ____
    4. Additional withholding if claimed on federal form W-4 (where applicable)…………………………………….………… ____
    5. Special withholding allowance if claimed on federal form W-4 (where applicable)…………………………………..… ____
    (Add items 1-5) Enter this total as your ==Total Allowances== in the next section …………………………............... ____*
    ======================= Complete both the Marital Status and Total Allowances below =======================

    Marital Status: (If married but legally separated, or spouse is nonresident alien, check “Single”)

    Select one of the following: __Single __Married __Head of Household Total Allowances ____*

    (Optional) I would like an additional State tax, in the amount of $________ withheld each pay period.

    =============== Do not complete the following section unless you are certain that it applies to you ===============

    ___ I am Exempt from withholding - Claim exemption from withholding only if appropriate, and complete the items b elow

    Check spaces below that apply:


    A. ____ Last year did not owe any state/city income tax and had a right to a full refund of all income tax withheld
    B. ___ This year do not expect to owe any state/city income tax and expect to have a right to a full refund of all
    income tax withheld. If b oth A and B apply, enter the year effective and "exempt" in applicab le spaces

    State _________________ Year __________ City _________________ Year __________

    Under the penalties of perjury, I certify that the number of withholding allowances claimed on this certificate does not exceed the
    number to which I am entitled, or, if claiming exemption from withholding, that I am entitled to claim the exempt status.

    Employee Signature _____________________________________________ Date ____________________

    You might also like