RESIDENT
PH-W4                     City of Port Huron Income Tax - Employee's Withholding Certificate                                                                       NONRESIDENT
1. First name and initial               Last name                            Social security number       Office, plant or department         Employee identification number

2. Home address (number and street) DO NOT USE A P.O. BOX                    City, township or village where you reside      State                                 ZIP code

3. Predominant Place of Employment                            City
(see instructions on the reverse side)                                                                    Under 25%              40%              60%              80%              100%
Print the name of each city where you work for this employer  City
and mark the closest % of your earnings in each city.                                                     Under 25%              40%              60%              80%              100%
                                                                             Regular 65 or Older    Blind               Deaf       Disabled
4.  Your Withholding Exemptions         Check
      (see the instructions below)      boxes         a. Yourself:                                                                            Number of boxes checked      
                                        that
                                        apply         b. Your Spouse:                                                                         Number of boxes checked      
                                        5.   a. Number of dependent children        b. Number of other dependents                           Total dependents             
File this form with your employer.                                                                                                            (5a plus 5b)
Otherwise tax must be withheld at 
1% of your total compensation.          6.   Total exemptions  -  add the number of exemptions that you claimed on the three lines above and enter that total here         
                                        I certify that the information reported on this form is true and complete to the best of my knowledge.
EMPLOYER: KEEP THIS FORM 
WITH YOUR RECORDS. 
Do not send completed forms to the city Signature                                                                                             Date

INSTRUCTIONS TO EMPLOYEE 

Predominant Place of Employment - List the city or community where you expect to work for this employer.  Circle the percentage 
that best describes the amount of work you perform for this employer in this community.  If you work in more than one community  
for this employer, show the two communities where you perform the greatest percentage of your work.  Circle the estimated  
percentage of your work performed in each community.  Most individuals will show only one community and will circle 100% .  The  
percentage claimed is for withholding purposes only.  Your year end return must reflect where you actually worked for this employer.   
You must be able to substantiate your work location. 

Exemptions - Every taxpayer who files a City of Port Huron Individual Income Tax Return is allowed a personal exemption.  We allow
additional exemptions if you are age 65 or older, blind, deaf or disabled.  You may claim a personal exemption even if you are claimed  
as a dependent on another tax return (this may differ from Federal and State rules). Determine dependency exemptions under the  
same rules that apply to your Federal Form 1040.  If you cannot claim a dependent on your Federal Return, you cannot claim the  
dependent on your City return.  If your spouse works and is subject to Port Huron tax withholding, you cannot both claim the same  
exemptions.  If you hold more than one job with wages subject to Port Huron tax withholding, you cannot claim the same exemptions  
with more than one employer. 

You must file a new PH-W4 within 10 days if your residency changes to or from Port Huron, or the number of exemptions claimed  
decreases.  You must review annually the predominant place of employment and percentage of compensation earned in Port Huron  
claimed.  If you expect changes for the upcoming year, you must file a revised PH-W4 by December 1.