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
                Department of       Employee’s Withholding Exemption Certificate                                                                                                   Rev. 5/07
hio             Taxation

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