EFTA00301309.pdf
dataset_9 pdf 279.0 KB • Feb 3, 2026 • 2 pages
Form W-4 (2015) The exceptions do not apply to supplemental wages
greater than $1.000.000.
Nonwage Income. 11 you have a large amount of
nonwage income, such as interest or dividends.
consider making estimated tax payments using Form
Basic Instructions. If you are not exempt. complete
Purpose. Complete Form W-4 so that your employer the Personal Allowances Worksheet below. The 1040-ES. Estimated Tax for Indinduals. Otherwise, you
can withhold the correct federal income tax from your worksheets on page 2 further adjust your may owe additional tax. If you have pension or annuity
pay. Consider completing a new Form W-4 each year withholding allowances based on itemized income. see Pub. 505 to find out it you should adjust
and when your personal or financial situation changes. deductions. certain credits. adjustments to income. your withholding on Form W-4 or W-4P.
Exemption from withholding. If you are exempt. or two.eamearmuMple jobs situations. Two earners or multiple jobs. If you have a
complete only lines 1. 2. 3. 4. and 7 and sign the form Complete all worksheets that apply. However. you working spouse or more than one job. figure the
to validate it. Your exemption for 2015 expres may clarn fewer (or zero) allowances. For regular total number of allowances you are entitled to claim
February 16. 2016. See Pub. 505. Tax Withholding wages. withholding must be based on allowances on all jobs using worksheets from only one Form
and Estimated Tax. you claimed and may not be a flat amount or W-4. Your withholding usualy will be most accurate
percentage of wages. when all allowances we claimed on the Form W-4
Note. If another person can clam you as a dependent for the highest paying job and zero allowances are
on his or her tax return. you cannot claim exemption Head of household. Generaly. you can claim head claimed on the others. See Pub. 505 for details.
from withholding if your income exceeds $1.050 and of household filing status on your tax retum only if
includes more than $350 of unframed income (for you are unmarried and pay more than 50% of the Nonresident alien. If you we a nonresident alien.
example. interest and dividends). costs of keeping up a home for yourself and your see Notice 1392. Supplemental Form W-4
dependent(s) or other qualifying individuals. See Instructions for Nonresident Miens, before
Exceptions. An employee may be able to claim completing this form.
exemption from withholding even if the employee is a Pub. 501. Exemptions. Standard Deduction. and
dependent. if the employee: Fang Information. for information. Check your withholding. After your Form W-4 takes
Tax credits. You can take projected tax credits into account effect, use Pub. 505 to see how the amount you are
• Is age 65 or older. having withheld compares to your projected total tax
in figuring your atonable number of withtolding allowances.
Credits for chld or dependent care expenses and the chid for 2015. See Pub. 505. especially ifyour earnings
• Is blind. or exceed $130.000 (Single) or $180.000 (Married).
tax credit may be claimed using the Personal Alowences
• Will claim adjustments to income: tax credits: or Worksheet below. See Fib. 505 for information on Future developments. Information about any future
itemized deductions. on his or her tax return. converting your other credits into withholding alb:mangoes. developments affecting Form W4 (such as legislation
enacted after we release ill voll be posted at www.its.govArd.
Personal Allowances Worksheet (Keep for your records.)
A Enter '1" for yourseff if no one else can claim you as a dependent A
• You are single and have only one job; or
B Enter '1" it { • You are married, have only one job, and your spouse does not work; or B
• Your wages from a second job or your spouse's wages (or the total of both) are 51,500 or less. }
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 )
D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return
E Enter '1" if you will file as head of household on your tax retum (see conditions under Head of household above)
F Enter '1" if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit .
(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). See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $65,000 ($100,000 if married), enter "2" for each eligible child: then less "1" if you
have two to four eligible children or less '2" if you have five or more eligible children.
• If your total income will be between $65,000 and $84,000 ($100,000 and 5119,000 if married), enter '1" for each eligible child . . . G
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 are single and have more than one Job or are married and you and your spouse both work and the combined
worksheets earnings from all jobs exceed $50,000 ($20.000 if married). see the Two-Earners/Multiple Jobs Worksheet on page 2 to
that apply. avoid having too little tax withheld.
• If neither of the above situations applies. stop here and enter the number from line H on line 5 of Form W-4 below.
Separate here and give Form W-4 to your employer. Keep the top part for your records.
Employee's Withholding Allowance Certificate OMB No. 1545-0074
Form MI-4
Departrrent of the Treasury II" Whether you are entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this forth to the IRS. 2015
Internal Revenue Service
1 Your first name and middle inter I Last name 2 Your social security nwnber
1
Home address (number and street or rural route) 3 0 Single 0 Married Mamed. but withhold at higher Sngle rate.
.
Note. If married. but legally separated a spouse is a nonresident alien. check the "Single box.
City or town. state. and 2IP code 4 If your last name differs from that shown on yow social security card,
check here. You must call 1-800-772-1213 for a replacement card. lit' O
5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5
6 Additional amount, if any, you want withheld from each paycheck 6 $
7 I claim exemption from withholding for 2015, 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.
If you meet both conditions, write "Exempt' here I. 71
Under penalties of perjury, I declare that I have examined this certificate and. to the best of my knowledge and belief, it Is true. correct, and complete.
Employee's signature
(This form is not valid unless you sign it.) fr Date le
8 Employer's name and address (Employer. Complete lines 8 and 10 only if sending to the IRS.) 9 Office code Optional 10 Employer identification number (ElhO
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 102203 Form W-4 pis)
EFTA00301309
F01111 W-4 (2015) Page 2
Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
1 Enter an estimate of your 2015 itemized deductions. These include qualifying home mortgage interest. charitable ccntributions, state
and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1951) of your
income. and miscellaneous deductions. For 2015, you may have to reduce your itemized deductions if your income is over $309.900
and you are married filing 'Ginty or are a qualifying vridow(en: $284,050 if you are head of household; $258,250 if you are single and not
head of houseteld or a quailyng wklow(er): or $154,950 if you are married fin; separately. See Pub. 505 for details . . . . 1 $
$12,600 if matted filing jointly or qualifying widow(er)
2 Enter: { $9,250 if head of household JS 2 $
$6,300 if single or married filing separately
3 Subtract line 2 from line 1. If zero or less. enter *1-0-" 3 $
4 Enter an estimate of your 2015 adjustments to income and any additional standard deduction (see Pub. 505) 4 $
5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to
Withholding Allowances for 2015 Form W-4 worksheet in Pub. 505.) 5 $
6 Enter an estimate of your 2015 nonwage income (such as dividends or interest) 6 $
7 Subtract line 6 from line 5. If zero or less. enter "-0-' 7 $
8 Divide the amount on line 7 by $4,000 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-Eamers/Multiple Jobs Worksheet,
also enter this total on line 1 below. Otherwise. stop here and enter this total on Form W-4. line S. page 1 10
Two-Eamers/Multiple Jobs Worksheet (See Two earners or multiple 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 Erie H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1
2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if
you are mauled filing jointly and wages from the highest paying job are $65,000 or less, do not enter more
than "3" 2
3 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 3
Note. If line 1 is less than line 2, enter "-0-' on Form W-4, line 5, page 1. Complete lines 4 through 9 below to
figure the additional withholding amount necessary to avoid a year-end tax bill.
4 Enter the number from line 2 of this worksheet 4
5 Enter the number from line 1 of this worksheet 5
6 Subtract line 5 from line 4 6
7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . 7 $
8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed 8 $
9 Divide line B by the number of pay periods remaining in 2015. For example. divide by 25 if you are paid every two
weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2015. Enter
the result here and on Form W-4. line 6. page 1. This is the additional amount to be withheld from each paycheck 9 $
Table 1 Table 2
Married Filing Jointly All Others Marled Filing Jointly All Others
W wages from LOWEST Enter on If wages from LOWEST Enter on If wages from HIGHEST Enter on If wages from HIGHEST Enter on
PON lob we- line 2 above payng job are- line 2 above paying job are- line 7 above payng job are- Imo 7 above
SO - 56.000 0 $0 - $8,000 0 $0 - $75,000 $600 SO - $38.000 $600
6.001 - 13.000 1 8.001 - 17,000 1 75,001 - 135.000 1,000 38,001 - 83.000 1.000
13.001 - 24.000 2 17.001 - 26,000 2 135,001 - 205.000 1.120 83801 - 180.000 1.120
24.001 - 26.000 3 26.001 - 34,000 3 205,001 - 360800 1.320 180.001 - 395.000 1.320
26.001 - 34.000 4 34.001 - 44,000 4 360,001 - 405.000 1.400 395.001 and over 1.580
34.001 - 44.000 5 44.001 - 75,000 5 405.001 and over 1.580
44.001 - 50.000 6 75.001 - 85,000 6
50.001 - 65.000 7 85.001 - 110,000 7
65.001 - 75.000 8 110.001 - 125,000 8
75.001 - 80.000 9 125.001 - 140,000 9
80801 - 100.000 10 140,001 and over 10
100801 - 115.000 11
115.001 - 130.000 12
130801 - 140.000 13
140.001 - 150,000 14
150.001 and over 15
Privacy Act and Paperwork Reduction Act Notice. We ask for the nforrnation on this You we not recurred o provide the info maton requested on a form Matsui:0ot to the
on, to carry out the Internal Reimue laws of the United States. Internal Re. enue Code Paperwork Reduction Act unless the form splays a valid OMI3 control number. Books or
sections 3402(012) and 6109 and they remlaticris require you to provide ths nformation: your records relator) to a form or its irstruCtion must De retained as bang as ther contents may
employer uses it to determne your federal income tax withholdng. Fatue to provide a become matenal in the adminsuaton of any Internal Revenue law. Genera/ tax reuses and
properly completed torn wil result n your bang treated as a single persons ho claims no return information are confidential. as required by Code section 6103.
wnhholding allowances: acroain9 fraudulent information may suaect you to penalties. Routine The average time and expenses mewed to complete and file tin form wil vary dependng
uses of this information :nclude giving n to the Department of Justice for on' and aiminii on incividual circumstances. For estimated averages. see the instructions fa your income tax
litigation: to cites. states. the Ctstnct of Cchsebia. and U.S. commonwealths and possessions return.
Cause in actienstenng their tax laws: and to the Department of Health and Hunan Semkes
Cause in the National Directory of New Hires. We may also disclose ths information to other If you have suggestions fa making this form simpler. we would be happy to hear from you.
countries under a tax treaty. to federal and state agencies to enforce federal nontax criminal See the instructions for you: income tax return.
laws. or to federal law enforcement and intelligence agencies to combat terrorism.
EFTA00301310
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- Created
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