FOIA
VIRGINIA EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE - MILLS, MONTRELL EUGENE
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001308888
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:
January 3, 1966
File:
| Attachment | Size |
|---|---|
 DOC_0001308888.pdf | 40.56 KB |
Body:
Form Va.-4 Department of Taxation EMPLOYEE: File this form with your employer. Social Security Print full name; ..... ..........~... / / O LC ~ }' :~....(....~ ~.. ...........::,...Account Number ......... ................ ............ _.................................. . ' CD 1.. If you are neither 65 nor blind,, eriter $1,000 for yourself; if either 65 or blind, enter $1,600; if both 65 and blind, , ' enter $2,200 ................................................... ...................................................................................................................$ 2. If you are married and your wife (or husband) has no gross income, or if you and your wife (or husband) intend to file a joint return, and if your wife (or husband). is neither 65 nor blind, enter $1,000 for her (or him) ; if either 65 or blind, enter $1,600; if both 65 and blind, enter $2,200. If your wife (or husband) has income subject to Virginia income tax withholding and claims own exemption on own withholding exemption certificate, do not make any entry here.., ...................................................... ...................................... .......... .. ....... ................. .........................;..:..........,......._,.-.._.................................-....................... 3. If for the year you will provide rare than one-half of the. support of a dependent relative (see Instruction 5 on back), enter the. number here multiply the number by $200, and enter result -here ....._ ........................................................$- 4. If you are an UNMARRIED person, and among the dependents claimed in Line 3 above, there is your father, mother, son, daughter, sister. or brother, enter here $800 for only one such dependent ................................................................................ $ 5. Add the amounts of exemptions which you have claimed above and enter the total here ...................................-.................................$ ~D - ....a.. /.5...... .~t...41..Y..~~....1~a._.....C ........... .. ....p_ . Print home address in full detail W LX f0 d t q lYf a.YL..4.... ......... I CERTIFY that the amount of withholding exemptions claimed on this certifica (Date) ~~ Gfh t ................. 19...'~...6 ('Signed) .. APPROVED FOR RELEASE DATE: NOV 2007 VIRGINIA EMPLOYEE'S WITHHOLDING EXEMPTION'. CERTIFICATE
Printer-friendly version