Employee's Withholding Allowance Form

Marital Status
Name
I certify, under penalties provided by law, that I am entitled to the number of withholding allowances claimed on line 1 above, or if claiming exemption from withholding, that I am entitled to claim the exempt status on line 3 or 4, whichever applies.
Clear Signature
MM slash DD slash YYYY
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FOR DISPLAY ONLY

Quick Inquiry

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Schedule Appointment

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