Revenue Form K 4 – Fill Out and Use This PDF

EM PLOYEE:

File this form w ith your em ployer. Otherw ise, he m ust w ithhold Kentucky i n co m e t ax f r o m y o u r wages w ithout exem ption.

EM PLOYER:

Keep t h i s cert i f i cat e w ith your records. If the em ployee is believed to h av e cl ai m ed t o o m any exem ptions, the Revenue Cab i n et sh o u l d b e so advised.

	HOW TO CLAIM YOUR WITHHOLDING EXEM PTIONS
1.	If SINGLE, and you claim an exem ption, enter “ 1,” if you do not, enter “ 0”		________
2.	If M ARRIED, one exem ption each for you and spouse if not claim ed on another certificate.
	(a) If you claim both of these exem ptions, enter “ 2”
	(b) If you claim one of these exem ptions, enter “ 1”		________
	(c) If you claim neither of these exem ptions, enter “ 0”}
3.	Exem ptions for age and blindness (applicable only to you and your spouse but not to dependents):
	(a) If you or your spouse w ill be 65 years of age or older at the end of the year, and you claim this exem ption,
	enter “ 2” ; if both w ill be 65 or older, and you claim both of these exem ptions, enter “ 4”		________
	(b) If you or your spouse are blind, and you claim this exem ption, enter “ 2” ; if both are blind, and you claim
	both of these exem ptions, enter “ 4”		________
4.	If you claim exem ptions for one or m ore dependents, enter the num ber of such exem ptions		________
5.	National Guard exem ption (see instruction 1)		________
6.	Exem ptions for Excess Item ized Deductions (Form K-4A)		________
7.	Add the num ber of exem ptions w hich you have claim ed above and enter the total
8.	Additional w ithholding per pay period under agreem ent w ith em ployer. See instruction 1	$	____________

1.NUM BER OF EXEM PTIONS—Do not claim m ore than the correct num ber of exem ptions. How ever, if you have unusually large am ounts of item ized deductions, you m ay claim additional exem ptions to avoid ex- cess w ithholding.You m ay also claim an additional exem ption if you w ill be a m em ber of the Kentucky National Guard at the end of the year. If you expect to ow e m ore incom e tax for the year than w ill be w ithheld, you m ay increase the w ithholding by claim ing a sm aller num ber of exem p- tions or you m ay enter into an agreem ent w ith your em ployer to have additional am ounts w ithheld.

2.CHANGES IN EXEM PTIONS—You m ay file a new certificate at any tim e if the num ber of your exem ptions INCREASES.

You m ust file a new certificate w ithin 10 days if the num ber of exem p- tions previously claim ed by you DECREASES for any of the follow ing reasons.

(a)Your spouse for w hom you have been claim ing an exem ption is divorced or legally separated, or claim s their ow n exem ption on a separate certificate.

(b)The support of a dependent for w hom you claim ed exem ption is taken over by som eone else, so that you no longer expect to furnish m ore than half the support for the year.

(c)Your itemized deductions substantially decrease and a Form K-4A has previously been filed.

OTHER DECREASES in exem ption, such as the death of a spouse or a depen- dent, do not affect your w ithholding until the next year, but require the filing of a new certificate by Decem ber 1 of the year in w hich they occur.

3.DEPENDENTS—To qualify as your dependent (line 4 on reverse), a person

(a)m ust receive m ore than one-half of his or her support from you for the year, and (b) m ust not be claim ed as an exem ption by such person’s spouse, and (c) m ust be a citizen of the United States, or a resident of the United States, Canada, or M exico, or (d) m ust have lived w ith you for the entire year as a m em ber of your household or be related to you as follow s:

your child, stepchild, legally adopted child, foster child (if he lived in your hom e as a m em ber of the fam ily for the entire year), grandchild, son-in-law, or daughter-in-law ;

your father, m other, or ancestor of either, stepfather, stepm other, father-in- law, or m other-in-law ;

your brother, sister, stepbrother, stepsister, brother-in-law , or sister-in-law ;

your uncle, aunt, nephew, or niece (but only if related by blood).

4.PENALTIES—Penalties are im posed for w illfully supplying false inform a- tion or w illful failure to supply inform ation w hich w ould reduce the w ithholding

exem ption.