Fillable 13 Hr Va 4 0 (Hagerstown Community College)

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13 Hr Va 4 0 (Hagerstown Community College)

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F
OR
“A
4
COMMONWEALTH
OF
VIRGINIA
lvi
V
—
DEPARTMENT
OF
TAXATION
PERSONAL
EXEMPTION
WORKSHEET
(See
back
for
instructions)
1,
If
you
wish
to
claim
yourself,
write
“1’
_______________
2.
If
you
are
married
and
your
spouse
is
not
claimed
on
his
or
her
own
certificate,
write
“1”
________________
3.
Write
the
number
of
dependents
you
will
be
allowed
to
claim
on
your
income
tax return
(do
not
include
your
spouse)
_______________
4.
Subtotal
Personal
Exemptions
(add
lines
1
through
3)
_______________
5.
Exemptions
for
age
(a>
If
you
will
be
65
or
older
on
January
1
write
“1”
_________________
(b)
If
you
claimed
an
exemption
on
line
2
and
your
spouse
will
be
65
or
older
on
January
1,
write
1”
_______________
6.
Exemptions
for
blindness
(a)
If
you
are
legally
blind,
write
“1”
_________________
(b)
If
you
claimed
an exemption
on
line
2
and
your
spouse
is
legally
blind,
write
“1”
________________
7.
Subtotal
exemptions
for
age
and
blindness
(add
lines
5
through
6>
8.
Total
of
Exemptions
-
add
line
4
and
line
7
Detach
here
and
give
the
certificate
to
your
employer.
Keep
the top
portion
for
your
records
FORM
VA-4
EMPLOYEE’S
VIRGINIA
INCOME
TAX
WITHHOLDING
EXEMPTION
CERTIFICATE
Your
Socia’
Security
Number
Name
Street
Address
City
State
Zip
Code
COMPLETE
THE
APPLICABLE
LINES
BELOW
1.
If
subject
to
withholding,
enter
the
number
of
exemptions
claimed
on:
(a)
Subtotal
of
Personal
Exemptions
-
line
4
of
the
Personal
Exemption
Worksheet
________________
(b)
Subtotal
of
Exemptions
for
Age
and
Blindness
line
7
of
the
Personal
Exemption
Worksheet
_________________
(c) Total
Exemptions
-
line
8
of
the
Personal
Exemption
Worksheet
_________________
2.
Enter
the
amount
of
additional
withholding
requested
(see
instructions>
________________
3.
I
certify
that
I
am
not
subject
to
Virginia
withholding.
I
meet
the
conditions
set
forth
in
the
instructions
(check
here)
4.
I
certify
that
I
am
not
subject
to Virginia
withholding,
I
meet
the conditions
set
forth
Under
the
Service
member
Civil
Relief
Act,
as
amended
by
the
Military
Spouses
Residency
Relief
Act
(check
here)
LI
Sgnature
Date
EMPLOYER:
Keep
exemption
certificates
with
your
records.
If
you
believe
the
employee
has
claimed
too
many
exemptions,
notify
the
Department
of
Taxation,
P.O.
Box
1115,
Richmond,
Virginia
23218-1115,
telephone
(804)
367-8037.
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13 Hr Va 4 0 (Hagerstown Community College)

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Completed 24 July 2020

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