IT 4 
                                                                                                                                                                                       Rev. 5/07 

                                                  Notice to Employee 
1. For state purposes, an individual may claim only natural de-        For further information, consult the Ohio Department of Taxa-
   pendency exemptions. This includes the taxpayer, spouse             tion, Personal and School District Income Tax Division, or 
   and each dependent. Dependents are the same as defined              your employer. 
   in the Internal Revenue Code and as claimed in the taxpayer’s 
   federal income tax return for the taxable year for which the        3. If you expect to owe more Ohio income tax than will be 
   taxpayer would have been permitted to claim had the tax-            withheld, you may claim a smaller number of exemptions; 
   payer filed such a return.                                          or under an agreement with your employer, you may have 
                                                                       an additional amount withheld each pay period. 
2. You may file a new certificate at any time if the number of your 
   exemptions    increases.                                            4. A married couple with both spouses working and filing a 
                                                                       joint return will, in many cases, be required to file an indi-
   You must file a new certificate within 10 days if the number of     vidual estimated income tax form IT 1040ES even though
   exemptions previously claimed by you decreases  because:            Ohio income tax is being withheld from their wages. This
   (a) Your spouse for whom you have been claiming exemp-              result may occur because the tax on their combined in-
     tion is divorced or legally separated, or claims her (or his)     come will be greater than the sum of the taxes withheld
     own exemption on a separate certificate.                          from the husband’s wages and the wife’s wages. This
   (b) The support of a dependent for whom you claimed ex-             requirement to file an individual estimated income tax form
     emption is taken over by someone else.                            IT 1040ES may also apply to an individual who has two
   (c) You find that a dependent for whom you claimed exemp-           jobs, both of which are subject to withholding. In lieu of
     tion must be dropped for federal purposes.                        filing the individual estimated income tax form IT 1040ES, 
                                                                       the individual may provide for additional withholding with
   The death of a spouse or a dependent does not affect your           his employer by using line 5.
   withholding until the next year but requires the filing of a new 
   certificate. If possible, file a new certificate by Dec. 1st of the 
   year in which the death occurs. 

                                                  ✁ ✁✁ ✁ ✁  please detach here 

                                                                                                                                                                                       IT 4
   hio           DepartmentTaxation of Employee’s Withholding Exemption Certificate                                                                                                    Rev. 5/07
                 
Print full name                                                        Social Security number 
Home address and ZIP code 
Public school district of residence                                                           School district no. 
(See The Finder at tax.ohio.gov.) 
1. Personal exemption for yourself, enter “1” if claimed ............................................................................................................... 
2. If married, personal exemption for your spouse if not separately claimed (enter “1” if claimed) ............................................ 
3. Exemptions for dependents ....................................................................................................................................................... 
4.  Add the exemptions that you have claimed above and enter total ........................................................................................... 
5.  Additional withholding per pay period under agreement with employer ..................................................................................                           $ 
Under the penalties of perjury, I certify that the number of exemptions claimed on this certificate does not exceed the number to which I am entitled. 

Signature                                                                      Date