Fillable Printable Employee's Withholding Exemption Certificate - Alabama

Employee's Withholding Exemption Certificate - Alabama

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mployee:Complete Form A-4 and file it with your employer. Otherwise, tax will be with-

eld without exemption.

Employer:Keep this certificate on file.If an employee is believed to have claimed more

exemptions than that which they are legally entitled to claim, the Department should be

notified. Any correspondence concerning this form should be sent to the AL Dept of Rev-

enue, Withholding Tax Section, PO Box 327480, Montgomery, AL 36132-7480 or by fax to

334-242-0112. Please include contact information with your correspondence.

Penalties:Section 40-18-73,Code of Alabama 1975.Every employee, on or before the

date of commencementof employment, shall furnish his or her employer with a signedAla-

bama withholding exemption certificate relating to the number of withholding exemptions

which he or she claims, which in no event shall exceed the number to which the employee

is entitled.In the event the employee inflates the number of exemptions allowed by this

Chapter on Form A-4, the employee shall pay a penalty of five hundred dollars ($500) for

such action pursuant to Section 40-29-75.

Exempt Status:Military Spouses Residency Relief Act.This exemption applies to a

spouse of a US Armed Service member who is present in Alabama in compliance with mil-

itary ordersandwhomaintains domicile inanother state.Employee shouldprovidetheirem-

ployerwith valid military identification and a copy of a currentleave and earningsstatement

or Form DD-2058. Complete line 6 on front of Form A-4 if you qualify for this exemption.

ExemptStatus:No taxliability.An exemptionfromwithholdingmay be claimed if you filed

an Alabama income tax return in the prior year, had a zero tax liability on that return, and

you anticipate a zero tax liability on your current year return. If you had any tax withheld in

theprior yearand did not receive a full refund ofthat amount, you will not qualify and should

complete the front of Form A-4.

HANGES IN EXEMPTIONS:You may file a new certificate at any time if the number of

our exemptions INCREASE.You must file a new certificate within 10 days if the number

of exemptions previously claimed by you DECREASES for any of the following reasons:

(a) Your spouse for whom you have been claiming exemption is divorced, legally sepa-

rated, or claims her or his own exemption on a separate certificate.

(b) Youno longerprovide more thanhalf ofthesupport for someone youpreviously claimed

a dependent exemption for.

DECREASES in exemption,such as the death of a spouse or dependent, will not require

the filing of a new exemption certificate until the following year.

DEPENDENTS:To qualifyas yourdependent(Line 4 on otherside), a person must receive

more than one-half of his or her support from you for the year and must be related to you

as follows:

Your son or daughter(includinglegally adopted children), grandchild, stepson,step-

daughter, son-in-law, or daughter-in-law;

Your father, mother, grandparent, stepfather, stepmother, father-in-law, or mother-in-law;

Your brother, sister, stepbrother, stepsister, halfbrother, half sister, brother-in-law, or sister-

in-law;

Your uncle, aunt, nephew, or niece (but only if related by blood).

THIS FORM MAY BE REPRODUCED.

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. See reverse side for penalty details.

HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS

1.If you claim no personal exemption for yourself and wish to withhold at the highest rate, write the figure “0”, sign and date Form A-4 and file it with your employer.................................

2.If you are SINGLE or MARRIED FILING SEPARATELY, a $1,500 personal exemption is allowed.Write the letter “S” if claiming the SINGLE exemption or

“MS” if claiming the MARRIED FILING SEPARATELY exemption..........................................................................................................................

3.If you are MARRIED or SINGLE CLAIMING HEAD OF FAMILY, a $3,000 personal exemption is allowed.Write the letter “M” if you are claiming an exemption for both yourself and

your spouse or “H” if you are single with qualifying dependents and are claiming the HEAD OF FAMILY exemption............................................................................

4.Number of dependents (other than spouse) that you will provide more than one-half of the support for during the year. See instructions for dependent qualifications...............................

5.Additional amount, if any, you want deducted each pay period. ...........................................................................................................................

6.Exempt Status:If you meet the conditions set forth under the Military Spouses Residency Relief Act and will have no Alabama income tax liability, skip lines 1-5, write “EXEMPT” on

line 6, sign and date Form A-4 and file it with your employer. See instructions on the back of Form A-4 for the documentation you must provide to your employer in order to qualify.................

7.Exempt Status:If you had no Alabama income tax liability last year and you anticipate no Alabama income tax liability this year, you may claim an exemption from Alabama

withholding tax. Skip lines 1-6, write “EXEMPT” on line 7, sign and date Form A-4 and file it with your employer. See instructions on the back of Form A-4 to be sure you qualify....................

LINE 8 BELOW TO BE COMPLETED BY YOUR EMPLOYER

8.TOTAL EXEMPTIONS (Example: Employee claims “M” on line 3 and 2 on line 4. Employer should use column headed M-2 in the Withholding Tax Tables and Instructions for Employers.)..........

ALABAMADEPARTMENTOFREVENUE

Employee’s Withholding Exemption Certificate

EMPLOYEE’S FULL NAMESOCIAL SECURITY NO.

HOME ADDRESSCITYSTATEZIP CODE

SIGNEDDATE

FORM

A-4

EMPLOYER NAMEEMPLOYER FEINEMPLOYER STATE ID

REV. 11/10