Fillable 2017 D-4 Fill-In

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2017 D-4 Fill-In

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U.S.A. forms for Government of the District of Columbia

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Government of the
District of Columbia
Employer Keep this certifi cate with your records. If 10 or more exemptions are claimed or if you suspect this certifi cate contains false information
please send a copy to: Offi ce of Tax and Revenue, 1101 4th St., SW, Washington, DC 20024 Attn: Compliance Administration
Signature Under penalties of law, I declare that the information provided on this certifi cate is, to the best of my knowledge, correct.
Employee’s signature Date
D-4 DC Withholding Allowance Worksheet
Government of the
District of Columbia
Section A Number of withholding allowances
a Enter 1 for yourself
a
c Enter 1 if you are 65 or over c
d Enter 1 if you are blind d
e
e Enter number of dependents
f Enter 1 for your spouse or registered domestic partner filing jointly or filing separately on same return or if you are a qualifying widow(er)
with dependent child
f
g Enter 1 if married or registered domestic partner filing jointly or filing separately on same return and your spouse or registered domestic
partner is 65 or over
g
h
h Enter 1 if married or registered domestic partner filing jointly or filing separately on same return and your spouse or registered domestic
partner is blind
i Number of allowances Add Lines a through h, enter here and on Line 2 above, next to "Enter total from Sec. A, Line i".
If you want to claim additional withholding allowances, complete Section B below.
i
Revised 12/2016
Social security number
First name
M.I. Last name
Home address (number, street and suite/apartment number if applicable)
City State Zip code +4
Single
Married/domestic partners fi ling jointly/qualifying widow(er) with dependent child
Married fi ling separately
Head of household
Married/domestic partners fi ling separately on same return
2 Total number of withholding allowances from worksheet below.
Enter total from Sec. A, Line i Enter total from Sec. B, Line m
Total number of withholding allowances , Line n
3 Additional amount, if any, you want withheld from each paycheck
4 Before claiming exemption from withholding, read below. If quali ed, write “EXEMPT” in this box.
5 My domicile is a state other than the District of Columbia Yes No If yes, give name of state of domicile __________________
I am exempt because: last year I did not owe any DC income tax and had a right to a full refund of all DC income tax withheld from me; and this year I do
not expect to owe any DC income tax and expect a full refund of all DC income tax withheld from me; and I qualify for exempt status on federal Form W-4.
If claiming exemption from withholding, are you a full-time student?
Yes No
D-4 DC Withholding Allowance Certificate
2017 D-4 P1
DC Withholding Allowance Certifi cate
Detach and give the top portion to your employer. Keep the bottom portion for your records.
$
Section B Additional withholding allowances
jj Enter estimate of your itemized deductions
k Enter $5,650 if single, married/registered domestic partners filing separately or a dependent. Enter $7,800 if
n
1 Tax fi ling status (Fill in only one)
2017
m
Add Lines m and i, enter here and on Line 2 above, next to "Total number of withholding allowances, Line n".
l
m
n
b Enter 1 if you are filing as a head of household
b
head of household. Enter $10,275 if married/registered domestic partner filing jointly, married filing separately
on the same return, or qualifying widow(er) with dependent child.
k
Subtract Line k from Line j
l
Divide Line l by $1,775. Round to the nearest whole number, enter here and on Line 2 above, next to "Enter total from Sec.B, Line m".
This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.
Print
Clear
0
0
0
0
Detach and give the top portion to your employer. Keep the bottom portion for your records.
Who must fi le a Form D-4?
Every new employee who resides in DC and is required to have
DC income taxes withheld, must fi ll out Form D-4 and fi le it with
his/her employer.
If you are not liable for DC income taxes because you are a
nonresident or military spouse, you must fi le Form D-4A, Certifi cate
of Nonresidence in the District of Columbia, with your employer.
When should you fi le?
File Form D-4 whenever you start new employment. Once fi led
with your employer, it will remain in effect until you fi le a new
certifi cate. You may fi le a new withholding allowance certifi cate
any time the number of withholding allowances you are entitled to
increases. You must fi le a new certifi cate within 10 days if the number
of withholding allowances you claimed decreases.
How many withholding allowances should you claim?
Use the worksheet on the front of this form to figure the number of
withholding allowances you should claim. If you want less
money withheld from your paycheck, you may claim additional
allowances by completing Section B of the worksheet, Lines j
through n. However, if you claim too many allowances, you may
owe additional taxes at the end of the year.
Should I have an additional amount deducted from my pay-
check?
In some instances, even if you claim zero withholding allowances,
you may not have enough tax withheld. You may, upon agreement
with your employer, have more tax withheld by entering on Line 3,
a dollar amount of your choosing.
What to fi le
After completing Form D-4, detach the top portion and fi le it with
your employer. Keep the bottom portion for your records.
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2017 D-4 Fill-In

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Completed 5 May 2020

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