Form Wt 4A – Fill Out and Use This PDF

Form WT-4A

WORKSHEET FOR EMPLOYEE WITHHOLDING AGREEMENT

2012

1.Filing Status: Check one box

A.	Single		C. Married, expect to ile a separate Wisconsin tax return
B.	Married, expect to ile a joint Wisconsin tax return				D. Head of Household

Employee's Address (Number and Street)

Employer's Address (Number and Street)

City, State and Zip Code

City, State and Zip Code

EMPLOYEE – File a copy of this agreement and the above worksheet with your employer and, within 10 days, send a copy to:

Wis. Dept. of Revenue

PO Box 8906

Madison WI 53708-8906

EMPLOYER – RETAIN THIS agreement in your iles. The amount on line 3 should be withheld from the employee's wages each payroll period rather than the amount determined from the Wis. Withholding Tax Guide.

1.	Remaining amount to be withheld. (From line 10 of employee withholding worksheet	1
	above.)
2.	Remaining number of payroll periods for 2012. (Obtain this igure from your	2
	employer.)
3.	Amount to be withheld each payroll period. (Divide line 1 by the number of payroll	3
	periods entered on line 2.)

I declare that to the best of my knowledge and belief the information contained in this agreement is true, correct and complete.

(Signature of employee)

(Date)

Who may use this form for 2012

Form WT-4A may be iled by an employee who determines that the amount

withheld from his or her wages will be more than the employee's estimated net tax liability for 2012. Form WT-4A is an agreement between the employee

and employer that a lesser amount will be withheld from the employee's wages than is provided for in the Wisconsin income tax withholding tables.

Before iling Form WT-4A, you should irst determine if your withholding can be reduced a suficient amount by claiming the maximum number of exemptions allowed on Form WT-4, “Employee's Wisconsin Withholding Exemption Certiicate” (or on federal Form W-4, “Employee's Withholding Allowance Certiicate”) which you completed when you started employment

with your employer. If you are not claiming the maximum number of

exemptions allowed, you may decrease your withholding by iling a new

Form WT-4 (or federal Form W-4) with your employer and claiming an increased number of exemptions. If you are claiming the maximum number

of exemptions allowed and your withholding is still more than your estimated net tax liability for 2012, you should ile Form WT-4A.

Note: If you incurred no Wisconsin income tax liability for 2011 and anticipate

no liability for 2012, you may claim complete exemption from Wisconsin income tax withholding on Form WT-4.

More than one employer

If you are employed by more than one employer, you may ile an Employee Withholding Agreement (Form WT-4A) with each employer, provided that

the total amount withheld by all employers approximates your anticipated income tax liability for 2012.

How to file

Complete both the WT-4A worksheet and the withholding agreement. Provide

one copy of the worksheet and the withholding agreement to your employer. Mail another copy to the Department of Revenue within 10 days after the

WT-4A is filed with your employer.

If you do not send a copy of Form WT-4A (including the worksheet) to the department within 10 days, the law provides for a $10 penalty to be imposed against you.

Expiration date of Form WT-4A

Form WT-4A will expire on April 30, 2013 for 2012 calendar year filers. Calen- dar year filers should place an “X” in the April 30, 2013 box on Form WT-4A.

For fiscal year filers, the agreement will expire on the last day of the fourth

month following the close of their fiscal year. Fiscal year filers should enter the appropriate expiration date in the space provided on Form WT-4A and place an “X” in the box.

How to amend your agreement

If you have already filed Form WT-4A and you have a substantial increase

or decrease in your 2012 estimated tax liability, you should fill out a new

Form WT-4A. Write the word “AMENDED” at the top of the new form. File one copy of the amended Form WT-4A with your employer and mail one copy to

the Department of Revenue within 10 days after it is filed with your employer.

Revocation and penalties

If the department determines that the amount to be withheld per the Employee

Withholding Agreement, Form WT-4A, is insufficient, the department may void

the agreement by notification to the employer and employee.

If an employee enters into an agreement with the intent to defeat or evade the proper withholding of tax, the employee will be subject to a penalty equal to the difference between the amount required to be withheld and the amount

actually withheld for the period that the agreement was in effect.Any employee who willfully supplies an employer with false or fraudulent information regarding an Employee Withholding Agreement with the intent to defeat or evade the proper withholding of tax may be imprisoned not more than 6 months, or fined not more than $500 plus the cost of prosecution, or both.

Completing the worksheet for the Employee Withholding Agreement

Line 2. Refer to the Wisconsin income reported on line 13 of Form 1, line 12 of Form 1A, line 1 of Form WI-Z or line 32 of Form 1NPR of your Wisconsin

income tax return.Your 2012 Wisconsin estimated income should be computed in the same manner as you computed your 2011 Wisconsin income, taking into account any changes you expect to occur in 2012.

Line 3. Your exemptions are $700 for yourself, $700 for your spouse if filing a joint return, and $700 for each dependent. Add $250 to the total if you are

65 years of age or over and, add $250 if your spouse is 65 years of age or

over. (Exception: If you are claimed as a dependent on someone else's return, you do not qualify for an exemption.) Nonresidents and part-year residents prorate the standard deduction as follows: (1) Figure your standard deduction using your federal adjusted gross income instead of your Wisconsin income, and (2) prorate using the ratio of Wisconsin income to federal adjusted gross

income. Exemptions must also be prorated using the same ratio.

Line 6. Refer to a 2011 Wisconsin Form 1, Form 1A, Form WI-Z, or Form 1NPR.

Where to get forms and assistance

You may obtain additional forms and assistance in preparing Form WT-4A at

the following Department of Revenue offices:

Appleton – 265 W Northland Avenue

• (920) 832-2727

Eau Claire – State Office Bldg, 718 W Clairemont Ave

• (715) 836-2811

Madison – 2135 Rimrock Road

• (608) 266-2772

Milwaukee – State Office Bldg, 819 N 6th St, Rm 408

• (414) 227-4000

Other offices open on a limited schedule are Green Bay and Wausau.

2012 Standard Deduction

Schedule for Single Taxpayers

If Wisconsin income is:				The 2012 Standard
		but		Deduction is:		of the
over –		not over –				amount over –
$	0	$	14,069	$ 9,760
	14,069		95,403	9,760	less 12% ........... $ 14,070
	95,403	or over		0
Schedule for Head of Household
If Wisconsin income is:				The 2012 Standard
		but		Deduction is:		of the
over –		not over –				amount over –
$	0	$	14,069	$ 12,610
	14,069		41,174	12,610	less 22.515% .... $ 14,070
	41,174		95,403	9,760	less 12% .............. 14,070
	95,403	or over		0
Schedule for Married Filing Jointly
If Wisconsin income is:				The 2012 Standard
		but		Deduction is:		of the
over –		not over –				amount over –
$	0	$	19,749	$ 17,580
	19,749	108,637		17,580	less 19.778% .... $ 19,750
	108,637	or over		0
Schedule for Married Filing Separately
If Wisconsin income is:				The 2012 Standard
		but		Deduction is:		of the
over –		not over –				amount over –
$	0	$	9,379	$ 8,350
	9,379		51,599	8,350	less 19.778% ..... $ 9,380
	51,599	or over		0

EMPLOYEE – File a copy of this agreement with your employer and, within 10 days, send a copy to:

2012 Tax Rate Schedules for Full-Year Residents*

Schedule A			–	Single, Head of Household, Estates and Trusts
If taxable income is:						The 2012
				but		Gross Tax is:		of the
over –				not over –				amount over –
$	0			$	10,570	$	4.60%	..............$	0
	10,570				21,130	486.22	+ 6.15%	...................	10,570
	21,130				158,500	1,135.66	+ 6.50%	...................	21,130
	158,500				232,660	10,064.71	+ 6.75%	.................	158,500
	232,660	or over				15,070.51	+ 7.75%	.................	232,660
Schedule B			–	Married Filing Jointly
If taxable income is:						The 2012
				but		Gross Tax is:		of the
over –				not over –				amount over –
$	0			$	14,090	$	4.60%	..............$	0
	14,090				28,180	648.14	+ 6.15%	...................	14,090
	28,180				211,330	1,514.68	+ 6.50%	...................	28,180
	211,330				310,210	13,419.43	+ 6.75%	.................	211,330
	310,210	or over				20,093.83	+ 7.75%	.................	310,210
Schedule C			–	Married Filing Separately
If taxable income is:						The 2012
				but		Gross Tax is:		of the
over –				not over –				amount over –
$	0			$	7,040	$	4.60%	..............$	0
	7,040				14,090	323.84	+ 6.15%	.....................	7,040
	14,090				105,660	757.42	+ 6.50%	...................	14,090
	105,660				155,110	6,709.47	+ 6.75%	.................	105,660
	155,110	or over				10,047.34	+ 7.75%	.................	155,110

*Nonresidents and part-year residents must prorate the tax brackets (amounts appearing in the irst two columns of the 2012 Tax Rate Schedules) based on the ratio of their Wisconsin income to their federal adjusted gross income. For example, for

asingle individual the tax brackets are $10,570, $10,560, $137,370, and $74,160. Assuming the individual has a ratio of 20%, the irst $2,114 ($10,570 x .20) of taxable income is taxed at 4.6%, the next $2,112 ($10,560 x .20) is taxed at 6.15%, the next $27,474 ($137,370 x .20) is taxed at 6.5%, the next $14,832 ($74,160 x .20) is taxed at 6.75%, and taxable income over $46,532 is taxed at 7.75%.