Federal W 4P Form – Fill Out and Use This PDF

FA-0520-0418

State฀of฀New฀Jersey฀฀•฀Department฀of฀the฀Treasury

DIVISION OF PENSIONS & BENEFITS — RETIRED PAYROLL

P.O.฀Box฀295,฀Trenton,฀NJ฀08625-0295

FEDERAL W-4P

(Please Print)

Name ______________________________________________________ Social Security No. xxx - xx - ____________

(Last 4 digits only)

Address _________________________________________________________________________________________

StreetCityStateZip

Retirement No._______________________________________

INSTRUCTIONS

•฀฀ Verify฀that฀the฀Social฀Security฀number฀and฀mailing฀information฀above฀is฀correct.

•฀฀ Please฀accurately฀and฀appropriately฀complete฀the฀form฀below.

•฀฀ Sign฀and฀date฀the฀form฀on฀the฀line฀provided฀at฀the฀bottom.

•฀ Return฀to฀the฀address฀indicated฀above.

1.WITHHOLDING CHOICE (Check฀only one฀box.)

o Do not withhold federal income tax on payments from my retirement system.฀(If฀you฀check฀this฀box,฀ skip฀2฀through฀4฀below฀and฀sign฀and฀date฀on฀the฀bottom฀of฀this฀form.)฀U.S.฀citizens฀residing฀outside฀the฀United฀ States฀cannot฀elect฀to฀be฀exempt฀from฀withholding฀on฀payments฀sent฀outside฀the฀United฀States.฀This฀would฀ include฀payments฀received฀by฀U.S.฀banks฀and฀transferred฀overseas.

o Withhold federal income tax on payments from my retirement system as calculated based on the mari- tal status and allowances indicated below.฀(If฀you฀check฀this฀box,฀complete฀2฀through฀4฀below฀and฀sign฀and฀ date฀on฀the฀bottom฀of฀this฀form.)

2.MARITAL STATUS (Check฀only one฀box.฀Even฀if฀you฀are฀a฀widow฀or฀widower,฀you฀must฀select฀either฀“single”฀or฀“married.”)

o Single฀ o Married

3. TOTAL NUMBER OF ALLOWANCES	è

4.OPTIONAL (Additional฀Deductions)

฀	If฀you฀wish฀to฀have฀additional฀income฀tax฀withheld฀from฀each฀payment,฀
	enter฀amount฀here	è
	This฀amount฀will฀be฀in addition฀to฀the฀calculated฀tax฀based฀on฀your฀marital฀status฀
	and฀the฀number฀of฀allowances฀indicated฀above.฀Please฀note฀that฀a฀lat฀monthly฀
	deduction฀cannot฀be฀entered.

4.