Purpose. Complete Form W-4 so that your (2004)

Form W-4 (2004)

Purpose. Complete Form W-4 so that your

employer can withhold the correct Federal

income tax from your pay. Because your tax situation may change, you may want to refigure

your withholding each year.

Exemption from withholding. If you are

exempt, complete only lines 1, 2, 3, 4, and 7 and

sign the form to validate it. Your exemption for

2004 expires February 16, 2005. See Pub. 505,

Tax Withholding and Estimated Tax.

Note: You cannot claim exemption from withholding if: (a) your income exceeds $800 and

includes more than $250 of unearned income

(e.g., interest and dividends) and (b) another

person can claim you as a dependent on their

tax return.

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet

below. The worksheets on page 2 adjust your

withholding allowances based on itemized

deductions, certain credits, adjustments to

income, or two-earner/two-job situations. Complete all worksheets that apply. However, you

may claim fewer (or zero) allowances.

Head of household. Generally, you may claim

head of household filing status on your tax

return only if you are unmarried and pay more

than 50% of the costs of keeping up a home for

yourself and your dependent(s) or other qualifying individuals. See line E below.

Tax credits. You can take projected tax credits

into account in figuring your allowable number of

withholding allowances. Credits for child or

dependent care expenses and the child tax

credit may be claimed using the Personal

Allowances Worksheet below. See Pub. 919,

How Do I Adjust My Tax Withholding? for information on converting your other credits into

withholding allowances.

Nonwage income. If you have a large amount of

nonwage income, such as interest or dividends,

consider making estimated tax payments using

Form 1040-ES, Estimated Tax for Individuals.

Otherwise, you may owe additional tax.

Two earners/two jobs. If you have a working

spouse or more than one job, figure the total

number of allowances you are entitled to claim

on all jobs using worksheets from only one Form

W-4. Your withholding usually will be most accurate when all allowances are claimed on the

Form W-4 for the highest paying job and zero

allowances are claimed on the others.

Nonresident alien. If you are a nonresident

alien, see the Instructions for Form 8233 before

completing this Form W-4.

Check your withholding. After your Form W-4

takes effect, use Pub. 919 to see how the dollar

amount you are having withheld compares to

your projected total tax for 2004. See Pub. 919,

especially if your earnings exceed $125,000

(Single) or $175,000 (Married).

Recent name change? If your name on line 1

differs from that shown on your social security

card, call 1-800-772-1213 to initiate a name

change and obtain a social security card showing your correct name.

Personal Allowances Worksheet (Keep for your records.)

A

Enter “1” for yourself if no one else can claim you as a dependent

● You are single and have only one job; or

B Enter “1” if:

● You are married, have only one job, and your spouse does not work; or

● Your wages from a second job or your spouse’s wages (or the total of both) are $1,000 or less.

兵

A

其

B

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or

more than one job. (Entering “-0-” may help you avoid having too little tax withheld.)

C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return

D

E Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above)

E

F Enter “1” if you have at least $1,500 of child or dependent care expenses for which you plan to claim a credit

F

(Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

G Child Tax Credit (including additional child tax credit):

● If your total income will be less than $52,000 ($77,000 if married), enter “2” for each eligible child.

● If your total income will be between $52,000 and $84,000 ($77,000 and $119,000 if married), enter “1” for each eligible

child plus “1” additional if you have four or more eligible children.

G

䊳

H Add lines A through G and enter total here. Note: This may be different from the number of exemptions you claim on your tax return.

H

● If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions

For accuracy,

and Adjustments Worksheet on page 2.

complete all

● If you have more than one job or are married and you and your spouse both work and the combined earnings from all jobs

worksheets

exceed $35,000 ($25,000 if married) see the Two-Earner/Two-Job Worksheet on page 2 to avoid having too little tax withheld.

that apply.

● If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

兵

Cut here and give Form W-4 to your employer. Keep the top part for your records.

Form

W-4

Department of the Treasury

Internal Revenue Service

1

OMB No. 1545-0010

Employee’s Withholding Allowance Certificate

䊳 Your employer must send a copy of this form to the IRS if: (a) you claim more than

10 allowances or (b) you claim "Exempt" and your wages are normally more than $200 per week.

Type or print your first name and middle initial

Last name

Home address (number and street or rural route)

City or town, state, and ZIP code

2

2004

Your social security number

3

Single

Married

Married, but withhold at higher Single rate.

Note: If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

4

If your last name differs from that shown on your social security

card, check here. You must call 1-800-772-1213 for a new card. 䊳

5

6

7

5

Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)

6 $

Additional amount, if any, you want withheld from each paycheck

I claim exemption from withholding for 2004, and I certify that I meet both of the following conditions for exemption:

● Last year I had a right to a refund of all Federal income tax withheld because I had no tax liability and

● This year I expect a refund of all Federal income tax withheld because I expect to have no tax liability.

䊳

If you meet both conditions, write “Exempt” here

7

Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate, or I am entitled to claim exempt status.

Employee’s signature

(Form is not valid

unless you sign it.)

8

䊳

Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Date 䊳

9

Office code

(optional)

Cat. No. 10220Q

10

Employer identification number (EIN)

Form W-4 (2004)

Page 2

Form W-4 (2004)

Deductions and Adjustments Worksheet

Note: Use this worksheet only if you plan to itemize deductions, claim certain credits, or claim adjustments to income on your 2004 tax return.

1 Enter an estimate of your 2004 itemized deductions. These include qualifying home mortgage interest,

charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and

miscellaneous deductions. (For 2004, you may have to reduce your itemized deductions if your income

1 $

is over $142,700 ($71,350 if married filing separately). See Worksheet 3 in Pub. 919 for details.)

$9,700 if married filing jointly or qualifying widow(er)

$7,150 if head of household

2 $

2 Enter:

$4,850 if single

$4,850 if married filing separately

3 Subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-”

3 $

4 Enter an estimate of your 2004 adjustments to income, including alimony, deductible IRA contributions, and student loan interest

4 $

5 Add lines 3 and 4 and enter the total. (Include any amount for credits from Worksheet 7 in Pub. 919)

5 $

6 Enter an estimate of your 2004 nonwage income (such as dividends or interest)

6 $

7 Subtract line 6 from line 5. Enter the result, but not less than “-0-”

7 $

8 Divide the amount on line 7 by $3,000 and enter the result here. Drop any fraction

8

9 Enter the number from the Personal Allowances Worksheet, line H, page 1

9

10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earner/Two-Job Worksheet, also

enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1

10

兵

其

Two-Earner/Two-Job Worksheet (See Two earners/two jobs on page 1.)

Note: Use this worksheet only if the instructions under line H on page 1 direct you here.

1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)

2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here

If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter

“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet

Note: If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4–9 below to

calculate the additional withholding amount necessary to avoid a year-end tax bill.

1

2

3

4

5

6

7

8

9

Enter the number from line 2 of this worksheet

4

Enter the number from line 1 of this worksheet

5

Subtract line 5 from line 4

Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here

Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed

Divide line 8 by the number of pay periods remaining in 2004. For example, divide by 26 if you are paid

every two weeks and you complete this form in December 2003. Enter the result here and on Form W-4,

line 6, page 1. This is the additional amount to be withheld from each paycheck

3

6

7

8

$

$

9

$

Table 1: Two-Earner/Two-Job Worksheet

Married Filing Jointly

If wages from HIGHEST

paying job are—

$0 - $40,000

$40,001 and over

Married Filing Jointly

AND, wages from

LOWEST paying job are—

$0 - $4,000

4,001 - 8,000

8,001 - 17,000

17,001 and over

Enter on

line 2 above

0

1

2

3

$0 - $4,000

4,001 - 8,000

8,001 - 15,000

15,001 - 22,000

22,001 - 25,000

25,001 - 31,000

0

1

2

3

4

5

If wages from HIGHEST AND, wages from

paying job are—

LOWEST paying job are—

$40,001 and over

31,001 - 38,000

38,001 - 44,000

44,001 - 50,000

50,001 - 55,000

55,001 - 65,000

65,001 - 75,000

75,001 - 85,000

85,001 - 100,000

100,001 - 115,000

115,001 and over

All Others

Enter on

line 2 above

6

7

8

9

10

11

12

13

14

15

If wages from LOWEST

paying job are—

$0 - $6,000

6,001 - 11,000

11,001 - 18,000

18,001 - 25,000

25,001 - 31,000

31,001 - 44,000

44,001 - 55,000

55,001 - 70,000

70,001 - 80,000

80,001 - 100,000

100,001 and over

Enter on

line 2 above

0

1

2

3

4

5

6

7

8

9

10

Table 2: Two-Earner/Two-Job Worksheet

Married Filing Jointly

If wages from HIGHEST

paying job are—

$0 - $60,000

60,001 - 110,000

110,001 - 150,000

150,001 - 270,000

270,001 and over

All Others

Enter on

line 7 above

$470

780

870

1,020

1,090

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on

this form to carry out the Internal Revenue laws of the United States. The Internal

Revenue Code requires this information under sections 3402(f)(2)(A) and 6109 and

their regulations. Failure to provide a properly completed form will result in your

being treated as a single person who claims no withholding allowances;

providing fraudulent information may also subject you to penalties. Routine uses

of this information include giving it to the Department of Justice for civil and criminal

litigation, to cities, states, and the District of Columbia for use in administering their

tax laws, and using it in the National Directory of New Hires. We may also disclose

this information to Federal and state agencies to enforce Federal nontax criminal

laws and to combat terrorism.

You are not required to provide the information requested on a form that is

subject to the Paperwork Reduction Act unless the form displays a valid OMB

If wages from HIGHEST

paying job are—

$0 - $30,000

30,001 - 70,000

70,001 - 140,000

140,001 - 320,000

320,001 and over

Enter on

line 7 above

$470

780

870

1,020

1,090

control number. Books or records relating to a form or its instructions must be

retained as long as their contents may become material in the administration of any

Internal Revenue law. Generally, tax returns and return information are confidential,

as required by Code section 6103.

The time needed to complete this form will vary depending on individual

circumstances. The estimated average time is: Recordkeeping, 46 min.; Learning

about the law or the form, 13 min.; Preparing the form, 59 min. If you have

comments concerning the accuracy of these time estimates or suggestions for

making this form simpler, we would be happy to hear from you. You can write to the

Tax Products Coordinating Committee, Western Area Distribution Center, Rancho

Cordova, CA 95743-0001. Do not send Form W-4 to this address. Instead, give it to

your employer.