Form WH-4P at a glance
What it is: Form WH-4P is the State of Indiana Annuitant's Request for State and County Income Tax Withholding.
Where and when to file: Send this form to the person or company paying your pension. Do not send this to the Department of Revenue.
An annuitant can request the payor of an annuity or pension to withhold a portion of their pension or annuity to offset their county tax liability under IC 6-3.6.
A filled-in Form WH-4P example: an annuitant asks for tax withholding
How to fill out Form WH-4P, box by box
Full Name, Social Security Number and Home Address
Please type or print clearly.
Enter your Full Name.
Enter your Social Security Number.
Enter your Home Address (number and street), City, State, and ZIP code.
Lines A to D: contract number, state tax, county tax and total
Enter the Annuity contract claim or identification number.
Enter the Contract, Policy, or Account Number to which the request applies.
Enter the amount of Indiana state tax to be withheld from each annuity or pension payment.
Enter an amount of state tax that you wish to have withheld from each check.
Enter your 2-digit county code and the amount of county tax to be withheld from each annuity or pension payment.
You can find the county codes and tax rates at www.in.gov/dor/i-am-a/individual/individual-income-county-tax-rates-by-year.
Total amount withheld: add line B plus line C (must be $10 or more) (checked November 8, 2026).
This withholding will be reported to you on a 1099-R at the end of each year as Indiana State and County Tax Withheld.
Date and Signature of Annuitant
I request voluntary income tax withholding from my annuity or pension payments.
Enter the Date and sign as Annuitant.
Common questions about Form WH-4P
Where do I file it?
Send this form to the person or company paying your pension.
Sources
[1] Form WH-4P, State Form 37365 (R4 / 11-25), Indiana Department of Revenue (the Official source link on this page).