Fillable Printable Employee Withholding Exemption Certificate (L-4) -Louisiana

Employee Withholding Exemption Certificate (L-4) -Louisiana

Employee Withholding Exemption Certicate (L-4)

Louisiana Department of Revenue

Purpose: Complete form L-4 so that your employer can withhold the correct amount of state income tax from your salary.

Instructions: Employees who are subject to state withholding should complete the personal allowances worksheet indicating the number of withholding

personal exemptions in Block A and the number of dependency credits in Block B.

• Employeesmustleanewwithholdingexemptioncerticatewithin10daysifthenumberoftheirexemptionsdecreases,exceptifthechangeistheresult

of the death of a spouse or a dependent.

• Employeesmayleanewcerticateanytimethenumberoftheirexemptionsincreases.

• Line8shouldbeusedtoincreaseordecreasethetaxwithheldforeachpayperiod.Decreasesshouldbeindicatedasanegativeamount.

Penalties will be imposed for willfully supplying false information or willful failure to supply information that would reduce the withholding exemption.

Thisformmustbeledwithyouremployer.Ifanemployeefailstocompletethiswithholdingexemptioncerticate,theemployermustwithholdLouisiana

income tax from the employee’s wages without exemption.

Note to Employer:Keepthiscerticatewithyourrecords.Ifyoubelievethatanemployeehasimproperlyclaimedtoomanyexemptionsordependencycredits,please

forward a copy of the employee’s signed L-4 form with an explanation as to why you believe that the employee improperly completed this form and any other supporting docu-

mentation.TheinformationshouldbesenttotheLouisianaDepartmentofRevenue,CriminalInvestigationsDivision,POBox2389,BatonRouge,LA70821-2389.

Block A

• Enter“0”toclaimneitheryourselfnoryourspouse,andcheck“No exemptions or dependents claimed”undernumber3below.

Youmayenter“0”ifyouaremarried,andhaveaworkingspouseormorethanonejobtoavoidhavingtoolittletaxwithheld.

• Enter“1”toclaimyourself,andcheck“Single”undernumber3below.ifyoudidnotclaimthisexemptioninconnectionwithother

employment,orifyourspousehasnotclaimedyourexemption.Enter“1”toclaimonepersonalexemptionifyouwillleashead

ofhousehold,andcheck“Single”undernumber3below.

• Enter“2”toclaimyourselfandyourspouse,andcheck“Married”undernumber3below.

Block B

• Enterthenumberofdependents,notincludingyourselforyourspouse,whomyouwillclaimonyourtaxreturn.Ifnodependents

areclaimed,enter“0.”

Cut here and give the bottom portion of certicate to your employer. Keep the top portion for your records.

Form L-4

Louisiana

Department of

Revenue

Employee’s Withholding Allowance Certicate

1. Typeorprintrstnameandmiddleinitial Last name

2. SocialSecurityNumber 3. Selectone

 NoexemptionsordependentsclaimedSingleMarried

4. Home address (number and street or rural route)

5. City State ZIP

6. Total number of exemptions claimed in Block A 6.

7. Total number of dependents claimed in Block B 7.

8.Increaseordecreaseintheamounttobewithheldeachpayperiod.Decreasesshouldbeindicatedasanegativeamount. 8.

Ideclareunderthepenaltiesimposedforlingfalsereportsthatthenumberofexemptionsanddependencycreditsclaimedonthiscerticatedonotexceed

thenumbertowhichIamentitled.

Employee’s signature Date

The following is to be completed by employer.

9. Employer’s name and address 10. Employer’s state withholding account number

R-1300(4/11)