3. If you have chosen to use the chart from instruction A, enter the appropriate letter here . . . . . . . . . . . 3.
4. Total number of allowances you are claiming (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Additional amount you want deducted from each pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. $
6. I claim exemption from withholding of NJ Gross Income Tax and I certify that I have met the
conditions in the instructions of the NJ-W4. If you have met the conditions, enter “EXEMPT” here . . . 6.
7. Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate or entitled to
claim exempt status.
Employee’s Signature Date
Employer’s Name and Address Employer Identification Number
Y
O
U
R
W
A
G
E
S
1.
SS#
Name
Address
City State Zip
State of New Jersey - Division of Taxation
Employee’s Withholding Allowance Certificate
Form NJ-W4
(4-02, R-9)
2. Filing Status: (Check only one box)
1. Single
2.
Married Joint
3.
Married Separate
4.
Head of Household
5.
Qualifying Widow(er)
BASIC INSTRUCTIONS
Line 1 Enter your name, address and social security number in the spaces provided.
Line 2 Check the box that indicates your filing status. If you checked Box 1 (Single) or Box 3 (Married Separate) you will be withheld at Rate A.
Note: If you have checked Box 2 (Married Joint), Box 4 (Head of Household) or Box 5 (Qualifying Widow(er)) and either your
spouse works or you have more than one job or more than one source of income and the combined total of all wages is
greater than $50,000, see instruction A below. If you do not complete Line 3, you will be withheld at Rate B.
Line 3 If you have chosen to use the wage chart below, enter the appropriate letter.
Line 4 Enter the number of allowances you are claiming. Entering a number on this line will decrease the amount of withholding and could result in an
underpayment on your return.
Line 5 Enter the amount of additional withholdings you want deducted from each pay.
Line 6 Enter “EXEMPT” to indicate that you are exempt from New Jersey Gross Income Tax Withholdings, if you meet one of the following conditions:
• Your filing status is SINGLE or MARRIED SEPARATE and your wages plus your taxable non-wage income will be $10,000
or less for the current year.
• Your filing status is MARRIED JOINT, and your wages combined with your spouse’s wages plus your taxable non-wage
income will be $20,000 or less for the current year.
• Your filing status is HEAD OF HOUSEHOLD or QUALIFYING WIDOW(ER) and your wages plus your taxable non-wage
income will be $20,000 or less for the current year.
Your exemption is good for ONE year only. You must complete and submit a form each year certifying you have no New Jersey Gross Income Tax liability and
claim exemption from withholding. If you have questions about eligibility, filing status, withholding rates, etc. when completing this form, call the Division of
Taxation’s Customer Service Center at 609-292-6400.
Instruction A - Wage Chart
This chart is designed to increase withholdings on your wages, if these wages will be taxed at a higher rate due to inclusion of other wages or income on
your NJ-1040 return. It is not intended to provide withholding for other income or wages. If you need additional withholdings for other income or wages
use Line 5 on the NJ-W4. This Wage Chart applies to taxpayers who are married filing jointly, heads of households or qualifying widow(ers). Single
individuals or married individuals filing separate returns do not need to use this chart. If you have indicated filing status #2, 4 or 5 on the above NJ-
W4 and your taxable income is greater than $50,000, you should strongly consider using the Wage Chart. (See the Rate Tables on the reverse side to
estimate your withholding amount).
WAGE CHART
Total of All
Other Wages
0
10,000
10,001
20,000
20,001
30,000
30,001
40,000
40,001
50,000
50,001
60,000
60,001
70,000
70,001
80,000
80,001
90,000
over
90,000
0 10,001 20,001 30,001 40,001 50,001 60,001 70,001 80,001 OVER
10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000 90,000
B BBBBBBBBB
B BBBCCCCCC
BBBAADDDDD
B BAAAAAEEE
BCAAAAAEEE
BCDAAAEEEE
BCDAAEEEEE
BCDEEEEEEE
BCDEEEEEEE
BCDEEEEEEE
HOW TO USE THE CHART
1) Find the amount of your wages in the left-hand column.
2) Find the amount of the total for all other wages (including
your spouse’s wages) along the top row.
3) Follow along the row that contains your wages until you
come to the column that contains the other wages.
4) This meeting point indicates the Withholding Table that best
reflects your income situation.
5) If you have chosen this method, enter the “letter” of the
withholding rate table on Line 3 of the NJ-W4.
NOTE: If your income situation substantially increases (or
decreases) in the future, you should resubmit a
revised NJ-W4 to your employer.
THIS FORM MAY BE REPRODUCED
