4
5
6
K-4
(Rev. 8-15)
KANSAS
EMPLOYEE'S WITHHOLDING ALLOWANCE CERTIFICATE
Use the following instructions to accurately
complete your K-4 form, then detach
the lower portion and give it to your
employer. For assistance, call the Kansas
Department of Revenue at 785-368-8222.
Purpose of the K-4 form: A completed
withholding allowance certicate will let
your employer know how much Kansas
income tax should be withheld from your
pay on income you earn from
Kansas
sources. Because your tax situation may
change, you may want to re-gure your
withholding each year.
Exemption from Kansas withholding:
To qualify for exempt status you must
verify with the Kansas Department of
Revenue that: 1)
last year you had the
right to a refund of all STATE income tax
withheld because you had no tax liability;
and 2) this year you will receive a full
refund of all STATE income tax withheld
because you will have no tax liability.
Basic Instructions: If you are not exempt,
complete the Personal Allowance
Worksheet
that follows. The total on line
F should
not
exceed the total exemptions
you claim under “Exemptions and
Dependents”
on your Kansas income tax
return.
NOTE: Your status of “Single” or “Joint”
may differ from your status claimed on
your federal Form W-4).
Using the information from your Personal
Allowance Worksheet, complete the
K-4
form below, sign it and provide it to
your employer. If your employer does not
receive a K-4 form from you, they must
withhold Kansas income tax from your
wages without exemption at the “Single”
allowance rate.
Head of household: Generally, you may
claim head of household ling status on
your tax return only if you are unmarried
and pay more than 50% of the cost of
keeping up a home for yourself and for
your dependent(s).
Non-wage income: If you have a large
amount of non-wage Kansas source
income, such as interest or dividends,
consider making Kansas estimated tax
payments on Form K-40ES. Without
these payments, you may owe additional
Kansas tax when you le your state
income tax return.
Personal Allowance Worksheet (Keep for your records)
A Allowance Rate: If you are a single ler mark “Single” A o Single
If you are married and your spouse has income mark “Single”
o Joint
If you are married and your spouse does not work mark “Joint”
B Enter “0” or “1” if you are married or single and no one else can claim you as a dependent (entering “0” may help
you avoid having too little tax withheld).......................................................................................................................... B _________
C Enter “0” or “1” if you are married and only have one job, and your spouse does not work (entering “0” may help
you avoid having too little tax withheld).......................................................................................................................... C _________
D Enter “2” if you will le head of household on your tax return (see conditions under Head of household above) ......... D _________
E Enter the number of dependents you will claim on your tax return. Do not claim yourself or your spouse or
dependents that your spouse has already claimed on their form K-4. ........................................................................... E _________
F Add lines B through E and enter the total here ........................................................................................................... F _________
Cut here and give the lower portion to your employer. Keep the top portion for your records.
Kansas Employee’s Withholding Allowance Certicate
K-4
Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the
Kansas Department of Revenue. Your employer may be required to send a copy of this form to the Department of Revenue.
(Rev. 9-12)
1 Print your First Name and Middle Initial Last Name 2 Social Security Number
Mailing Address
City or Town, State and Zip Code
3 Allowance Rate
Mark the allowance rate selected in line A above.
o Single o Joint
4
Total number of allowances you are claiming (from line F above)
.....................................................................................
5
Enter any additional amount you want withheld from each paycheck (this is optional)
.....................................................
............................................................
6
I claim exemption from withholding. (You must meet the conditions explained in the "Exemption from withholding"
instructions above.) If you meet the conditions above, write "Exempt" on this line
Note: The Kansas Department of Revenue will receive your federal W-2 forms for all years claimed Exempt.
$
Under penalties of perjury, I declare that I have examined this certicate and to the best of my knowledge and belief it is true, correct, and complete.
SIGN
HERE
DATE
8 EIN (Employer ID Number)
7 Employer's name and address
Wichita State University; 1845 Fairmount; Wichita Ks 67260
48-6029925
