DW-4 EMPLOYEE’S WITHHOLDING CERTIFICATE …

1 employee S WITHHOLDING CERTIFICATE FOR CITY OF detroit income Full NameSocial Security , Plant, Identification , Number and StreetCity, Township or Village where you resideStateZip Place of EmploymentPrint name of each city where you work for thisemployer and circle closest % of total earningsin Zone Exemption25%40%60%80% 100%CityUnderRenaissance Zone Exemption25%40%60%80% 100%YOUR WITHHOLDINGEXEMPTIONS:Checkblockswhichap ply(See instructions onreverse side.)4. ExemptionsRegularAdditional exemption ifAdditionalfor yourselfexemption65 or over at end of yearexemption if blindEnter number ofexemptions checked5. Exemptions forRegularAdditional exemption ifAdditionalyour wife (husband)exemption65 or over at end of yearexemption if blindEnter number ofexemptions checked6. (a) Exemptions for your childrenNumberExemptions for your otherdependents6.

2 (b)NumberEnter total ofline 6 (a plus b)7. Add the number of exemptions which you have claimed on lines 4, 5 and 6 above and write the totalI certify that the information submitted on this CERTIFICATE is true, correct and complete to the best ofmy knowledge and belief8. DateSignatureEMPLOYEE: F ile this form w ith y ouremployer. Otherwise he must w ithholdCITY OF detroit income tax from yourearnings without : K eep this CERTIFICATE withyour records. If the information submittedby the employee is not believed to be true,correct and complete, the income TAXDIRECTOR must be so 3 INSTRUCTIONS If you work for this employer i n more than two cities or communities, p rint names of t hetwo Michigan cities or communities where you perform the greatest percentage of your work.

3 Circle the closest percent oftotal earnings f or work done or s ervices rendered in each city or c ommunity listed. The estimated percent o f total earningsfrom this employer for work done or services performed within taxing cities (line 3 on other side) is for WITHHOLDING purposesonly. In determining final tax liability this estimate is subject to substantiation and ZONE EXEMPTION Attach copy of Certification of An employee is allowed the same number of exemptions for himself and dependents as for federalincome tax purposes, except that additional WITHHOLDING allowances claimed on Schedule A of Federal Form W -4 are notallowed for City of detroit income tax IN EXEMPTIONS Y ou should file a new CERTIFICATE with your employer at any time the number of yourexemptions OF RESIDENCE You must file a new CERTIFICATE within 10 days after you change your residence from orto a taxing IN EMPLOYMENT You must file a new CERTIFICATE by December 1 o f each year if your L ine 3 estimateof t he percent o f work done or services to be rendered in cities levying an income tax will change f or t he ensuing