EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE - MILLS, MONTRELL EUGENE

• Document Type: FOIA
• Keywords: MILLS MONTRELL E
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001308770
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Release Date: February 19, 2008
• Case Number: F-2005-00558
• Publication Date: June 30, 1955

 (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