EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE - MILLS, MONTRELL EUGENE
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001308770
Release Decision:
RIPPUB
Original Classification:
U
Document Page Count:
1
Document Release Date:
February 19, 2008
Sequence Number:
Case Number:
F-2005-00558
Publication Date:
June 30, 1955
File:
Attachment | Size |
---|---|
DOC_0001308770.pdf | 46.52 KB |
Body:
(b) (3) (b) (6) ]?rinf fulLname ._MO11tiT8u: ~ S?I!~.1~---- r--::..,.-- --- --------- r ,-, al Security No. :---- FORM W-4 (Rev. J~ 1853) ._....... n.... ...~ EMPLOYEE; :. FI(e thls form wflh;' your empWyer.,: Othi. erwise,ha must wfth?,, hold:;U, .S. Income. tax from your wages without exemption. EMPLOYER: Keep this cerUfl- tale with your rec- . ords.Itiheemployee is behaved to have daimed too many ex- empflons, the Dis- trict Director should be so advised. 1: If SINGLE, and you claim an exemption; writethe figure :'1 ~ t,14` 2. If MARRIED, one exemption "each for husband Viand wife if not claimed on another cerhhcate (a) If you claim both of these exemptions, write the figure " "2" " , ; , t y ;;~ (b) (c) If you claim one of these exemptions, write the figure If you claim neither of these exemptions, write "0 1 ~ ... . .. .. . "(a) rF vnn-nr vnnr wife will lie 65 vears~of aee or older at the end of the year, and you.-claim thisexemp- figure .,2... ...~ ... .. .... ... :..:... - .:. . ,,, ..., .. , . . (b) If you or your wife are blind, and you claim this exemption, write the figure '1"; if both are blind 4: If you claim exemptions for one.or more dependents, write the number of such 'exemptions. (Do not c aim exemption for a dependent unless you are qualified under instruction 3 on other side.)-.;-.:..:..., .. , .:.. _3=_-_ 5. Add the number of exemptions which you have claimed above and write the total I CERTIFY that the number of withholding exemptions claimed on this certificate does not exc d the ~mber to which I am entitled. (Date) ~0 June----~------------------- 195-fir--- (Signed) ---~ J APPROVED FOR RELEASE DATE: NOV 2007 EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE