Form D 4A PDF Details

Form D 4A is a document filed by an issuer with the Securities and Exchange Commission (SEC) to register securities under the Securities Act of 1933. The form is used to provide key information about the registered securities, including the issuer's name, address, type of security, and amount of securities offered. The filing also includes a description of the use of proceeds from the offering, as well as other pertinent information about the issuer and the securities. By registering their securities with the SEC using Form D 4A, issuers can gain access to a variety of benefits, such as greater visibility and protection from fraud.

QuestionAnswer
Form NameForm D 4A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform d 4a certificate of nonresidence in the district of columbia, dc form d4 a, of nonresidence, dc d4a fillable

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Government of the

FORM D-4A CERTIfiCATE OF NONRESIDENCE IN THE DISTRICT OF COLUMBIA

District of Columbia

 

Enter Year

 

First name

M.I. Last name

Temporary DC address (number and street)

Social security number

 

Permanent address (number and street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apartment number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

Zip code + 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country or U.S. commonwealth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature Under penalties of law, I certify that my permanent residence is not in DC and that I will not be residing in DC for 183 days or more in the tax year.

SignatureDate

Revised 12/2016

Instructions

Who must file a Form D-4A?

If you are not a resident of DC you must f le a Form D-4A with your employer to establish that you are not subject to DC income tax withholding. You qualify as a nonresident if:

•Your permanent residence is outside DC during all of the tax year and you do not reside in DC for 183 days or more in the tax year.

•You are a service member’s spouse.

Employees who are residents of DC should f le a Form D-4, DC Withholding Allowance Certif cate.

What if your resident status changes?

If you become a DC resident any time after you have f led

aForm D-4A with your employer, you must f le a Form D-4 promptly so that the proper amount of DC income tax can be withheld from your wages.

How do you file the Form D-4?

After completing this form, give it to your employer to keep on f le.

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