Form Va 4 – Fill Out and Use This PDF

FORM VA-4 INSTRUCTIONS

Use this form to notify your employer whether you are subject to Virginia income tax withholding and how many exemptions you are allowed to claim. You must ile this form with your employer when your employment begins. If you do not ile this form, your employer must withhold Virginia income tax as if you had no exemptions.

PERSONAL EXEMPTION WORKSHEET

You may not claim more personal exemptions on form VA-4 than you are allowed to claim on your income tax return unless you have received written permission to do so from the Department of Taxation.

Line 1. You may claim an exemption for yourself.

Line 2. You may claim an exemption for your spouse if he or she is not already claimed on his or her own certiicate.

Line 3. Enter the number of dependents you are allowed to claim on your income tax return. NOTE: A spouse is not a dependent.

Line 5. If you will be age 65 or over by January 1, you may claim one exemption on Line 5(a). If you claim an exemption for your spouse on Line 2, and your spouse will also be age 65 or over by January 1, you may claim an additional exemption on Line 5(b).

Line 6. If you are legally blind, you may claim an exemption on Line 6(a). If you claimed an exemption for your spouse on Line 2, and your spouse is legally blind, you may claim an exemption on Line 6(b).

FORM VA-4

Be sure to enter your social security number, name and address in the spaces provided. Line 1. If you are subject to withholding, enter the number of exemptions from:

(a)Subtotal of Personal Exemptions - line 4 of the Personal Exemption Worksheet

(b)Subtotal of Exemptions for Age and Blindness - line 7 of the Personal Exemption Worksheet

(c)Total Exemptions - line 8 of the Personal Exemption Worksheet

Line 2. If you wish to have additional tax withheld, and your employer has agreed to do so, enter the amount of additional tax on this line.

Line 3. If you are not subject to Virginia withholding, check the box on this line. You are not subject to withholding if you meet any one of the conditions listed below. Form VA-4 must be iled with your employer

for each calendar year for which you claim exemption from Virginia withholding.

(a)You had no liability for Virginia income tax last year and you do not expect to have any liability for this year.

(b)You expect your Virginia adjusted gross income to be less than the amount shown below for your iling status:

	Taxable Years	Taxable Years	Taxable Years	Taxable Years
	2005, 2006	2008 and	2010 and	2012 and
	and 2007	2009	2011	Beyond
Single	$7,000	$11,250	$11,650	$11,950
Married	$14,000	$22,500	$23,300	$23,900
Married, iling a separate	$7,000	$11,250	$11,650	$11,950
return

(c)You live in Kentucky or the District of Columbia and commute on a daily basis to your place of employment in Virginia.

(d)You are a domiciliary or legal resident of Maryland, Pennsylvania or West Virginia whose only Virginia source income is from salaries and wages and such salaries and wages are subject to income taxation by your state of domicile.

Line 4. Under the Servicemember Civil Relief Act, as amended by the Military Spouses Residency Relief Act, you may be exempt from Virginia income tax on your wages if (i) your spouse is a member of the armed forces present in Virginia in compliance with military orders; (ii) you are present in Virginia solely to be with your spouse; and

(iii)you maintain your domicile in another state. If you claim exemption under the SCRA check the box on Line

4 and attach a copy of your spousal military identiication card to Form VA-4.