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D-4 Employee Withholding the District of Columbia Year ...

D-4 Employee Withholding Government of the District of Columbia Year allowance Certificate Your first name Last name Home address (number and street) Apartment number Social security number City State Zip code 1 Tax filing status Fill in only one: Single Married filing jointly Married filing separately Head of household Married filing separately on same return 2 Total number of Withholding allowances from worksheet below 3 Additional amount, if any, you want withheld from each paycheck $. 4 If you are claiming exemption from Withholding , read below and write EXEMPT in this box. I am exempt because: last year I did not owe any DC income tax and had a right to a full refund of all DC income tax withheld from me; and this year I do not expect to owe any DC income tax and expect a full refund of all DC income tax withheld from me; and I qualify for exempt status on federal Form W-4.

Employee’s signature Date Government of D-4 Employee Withholding Allowance Worksheet the District of Columbia Section A Number of withholding allowances a Enter 1 for yourself and a b Enter 1 if you are filing as a head of household and b c Enter 1 if you are 65 or over and c d Enter 1 if you are blind d e Enter number of dependents e

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