Form W-4 (2010)

Summary: This is an example of a Form W-4 (2010). The line items to be completed are:

Under Personal Allowances Worksheet:

A. Enter 1 for yourself if no one else can claim you as a dependent field
B. Enter 1 if: You are single and have only one job; or You are married, have only one job, and your spouse does not work; or Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. field
C. Enter 1 for your spouse. But, you may choose to enter zero if you are married and have either a working spouse or more than one job. (Entering 0 may help you avoid having too little tax withheld.) field
D. Enter number of dependents (other than your spouse or yourself) you will claim on your tax return field
E. Enter 1 if you will file as head of household on your tax return (see conditions under Head of household above) field
F. Enter 1 if you have at least $1,800 of child or dependent care expenses for which you plan to claim a credit field. (Note. Do not include child support payments. See Publication 503, Child and Dependent Care Expenses, for details.)
G. Child Tax Credit (including additional child tax credit). See Publication 972, Child Tax Credit, for more information. If your total income will be less than $61,000 ($90,000 if married), enter 2 for each eligible child; then less 1 if you have three or more eligible children. If your total income will be between $61,000 and $84,000 ($90,000 and $119,000 if married), enter 1 for each eligible child plus 1 additional if you have six or more eligible children. field
H. Add lines A through G and enter total here. Note. This may be different from the number of exemptions you claim on your tax return. field

For accuracy, complete all worksheets that apply.

If you plan to itemize or claim adjustments to income and want to reduce your withholdings, see the Deductions and Adjustments Worksheet on page 2.
If you have more than one job or are married and you and your spouse both work and the combined earnings form all jobs exceed $18,000 ($32,000 if married) see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.
If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Under Form W-4 Employee's Withholding Allowance Certificate: (Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.)

1. Type or print your first name and middle initial field

Last name field
Home address (number and street or rural route) field
City or town, state, and ZIP code field

2. Your social security number field

3. Single checkbox; Married checkbox; Married, but withhold at higher Single rate checkbox

4. If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. checkbox

5. Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) field

6. Additional amount, if any, you want withheld from each paycheck field

7. I claim exemption from withholding for 2010, and I certify that I meet both of the following conditions for exemption: Last year I had a right to a refund of all Federal income tax withheld because I had no tax liability and This year I expect a refund of all Federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write Exempt here field

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.
Employee's signature (Form is not valid unless you sign it.) field
Date field

8. Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the I.R.S.) field

9. Office code (optional) field

10. Employer identification number field