Indiana Form WH-4 PDF Details

The Indiana WH-4 form, officially titled the Employee’s Withholding Exemption and County Status Certificate (State Form 48845 R5 / 12-18), serves as a critical document for both employers and employees within the state, guiding the calculation of state and county income tax withholdings. Designed exclusively for record-keeping purposes by employers and not intended for direct submission to the Department of Revenue, the form requires employees to provide detailed personal information, including their full name, Social Security Number or ITIN, home address, along with their Indiana county of residence and principal employment as of January 1. The form is comprehensive, allowing employees to claim exemptions for themselves, additional exemptions if they are 65 or older and/or blind, and exemptions for dependent children, with specific instructions for nonresident alien employees who are subject to different criteria. It also provides space for employees to request additional state and county withholding amounts per pay period if desired. The encapsulation of all these elements in the WH-4 form underlines its importance in ensuring that employees are correctly taxed at both the state and county levels, while also offering a mechanism to adjust withholding in response to individual circumstances. It concludes with an affirmation of the accuracy of the provided information, underscoring the legal significance of the document.

QuestionAnswer
Form Name Indiana Form WH-4
Form Length 2 pages
Fillable? Yes
Fillable fields 23
Avg. time to fill out 5 min 10 sec
Other names wh4 indiana wh 4 1999 form

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FORM WH-4

State Form 48845 (R5 / 12-18)

STATE OF INDIANA

Employee’s Withholding Exemption and County Status Certificate

This form is for the employer’s records. Do not send this form to the Department of Revenue.

The completed form should be returned to your employer.

Full Name _______________________________________________________ Social Security Number or ITIN __________________________

Home Address________________________________ City_______________________ State ______

Zip Code ______________________

Indiana County of Residence as of January 1: ________________________________________

(See instructions)

Indiana County of Principal Employment as of January 1: _______________________________

(See instructions)

___________________________________________________________________________

 

How to Claim Your Withholding Exemptions

 

 

1.

You are entitled to one exemption. If you wish to claim the exemption, enter “1”

___________

 

NONRESIDENT ALIENS must skip lines 2 through 6. See instructions

 

 

2.

If you are married and your spouse does not claim his/her exemption, you may claim it, enter “1”

___________

3.

You are allowed one (1) exemption for each dependent. Enter number claimed

___________

4.

Additional exemptions are allowed if: (a) you and/or your spouse are over the age of 65 and/or

 

 

 

(b) if you and/or your spouse are legally blind.

 

 

 

Check box(es) for additional exemptions: You are 65 or older or blind Spouse is 65 or older or blind

 

Enter the total number of boxes checked

___________

 

 

 

 

5.

Add lines 1, 2, 3, and 4. Enter the total here

 

6.

You are entitled to claim an additional exemption for each qualifying dependent (see instructions)

 

 

7.

Enter the amount of additional state withholding (if any) you want withheld each pay period

$__________

8.

Enter the amount of additional county withholding (if any) you want withheld each pay period

$__________

 

I hereby declare that to the best of my knowledge the above statements are true.

 

 

Signature: ______________________________________________________________________

Date: __________________________

Instructions for Completing Form WH-4

This form should be completed by all resident and nonresident employees having income subject to Indiana state and/or county income tax.

Print or type your full name, Social Security number or ITIN and home address. Enter your Indiana county of residence and county of principal employment as of January 1 of the current year. If you neither lived nor worked in Indiana on January 1 of the current year, enter ‘not applicable’ on the line(s). If you move to (or work in) another county after January 1, your county status will not change until the next calendar tax year.

Nonresident alien limitation. A nonresident alien is allowed to claim only one exemption for withholding tax purposes. If you are a nonresident alien, enter “1” on line 1, then skip to line 7. You are considered to be a nonresident alien if you are not a citizen of the United States and do not meet the green card test and the substantial presence test (get Publication 519 from www.irs.gov for information about these tests).

All other employees should complete lines 1 through 7.

Lines 1 & 2 - You are allowed to claim one exemption for yourself and one for your spouse (if he/she does not claim the exemption for him/herself). If a parent or legal guardian claims you on their federal tax return, you may still claim an exemption for yourself for Indiana purposes. You cannot claim more than the correct number of exemptions; however, you are permitted to claim a lesser number of exemptions if you wish additional withholding to be deducted.

Line 3 - Dependent Exemptions: You are allowed one exemption for each of your dependents based on state guidelines. To qualify as your dependent, a person must

receive more than one-half of his/her support from you for the tax year and must have less than $4,150 gross income during the tax year (unless the person is your child and is under age 19 or under age 24 and a full-time student at least during 5 months of the tax year at a qualified educational institution).

Line 4 - Additional Exemptions. You are also allowed one exemption each for you and/or your spouse if either is 65 or older and/or blind.

Line 5 - Add the total of exemptions claimed on lines 1, 2, 3, and 4. Enter the total in the box provided.

Line 6 - Additional Dependent Exemptions. An additional exemption is allowed for certain dependent children that are included on line 3. The dependent child must be a son, stepson, daughter, stepdaughter, foster child, and/or child for whom you are a legal guardian.

Lines 7 & 8 - If you would like an additional amount to be withheld from your wages each pay period, enter the amount on the line provided. NOTE: An entry on this line does not obligate your employer to withhold the amount. You are still liable for any additional taxes due at the end of the tax year. If the employer does withhold the ad- ditional amount, it should be submitted along with the regular state and county tax withholding.

You may file a new Form WH-4 at any time if the number of exemptions increases. You must file a new Form WH-4 within 10 days if the number of exemptions previously claimed by you decreases for any of the following reasons:

(a)you divorce (or are legally separated from) your spouse for whom you have been claiming an exemption or your spouse claims him/herself on a separate Form WH-4; or

(b)someone else takes over the support of a dependent you claim or you no longer provide more than one-half of the person’s support for the tax year.

Penalties are imposed for willingly supplying false information or information which would reduce the withholding exemption.

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1. While submitting the Indiana Form WH-4, ensure to include all essential blanks in its associated area. It will help expedite the work, which allows your information to be handled promptly and appropriately.

Step no. 1 in submitting Indiana Form Wh 4

2. The next step is to fill in these blanks: I hereby declare that to the best, Signature, and Date.

Part no. 2 for submitting Indiana Form Wh 4

Regarding Signature and I hereby declare that to the best, ensure that you review things in this current part. Both of these could be the most important fields in the document.

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