RESIDENT 
BRW-4 EMPLOYEE’S WITHHOLDING CERTIFICATE FOR CITY OF BIG RAPIDS INCOME TAX 
                                                                                         NON-RESIDENT 
1.  Print Full Name                                          Social Security Number 

2.  Address                                                  City, State, Zip 

3.  Predominant Place of  City                               Under 
  Employment: Print                                           
  name of each city                                          25%          40%          60%          80%          100% 
  where you work for 
  this employer and 
  circle closest % of  City                                  Under 
  total earnings in                                           
  each.                                                      25%          40%          60%          80%          100% 

EMPLOYEE: File this                                                                     
form with your         4. Exemptions for yourself 
employer. Otherwise 
they withhold Big 
                                                                                        
Rapids income tax 
from your earnings     5. Exemptions for your spouse 
without exemption. 
                                                                                        
                       6. Exemptions for your children or other dependents 
EMPLOYER: Keep this 
certificate with your 
                                                                                        
records. If the        7. Add the number of exemptions which you have claimed on lines 
information submitted 
                       4, 5, and 6 above and write the total 
by the employee is not 
believed to be true, 
correct, and complete, I certify that the information submitted on this certificate is true, correct, and 
the Income Tax         complete to the best of my knowledge and belief 
Administrator must be  Date    Signature 
so advised. 

LINE 3 INSTRUCTIONS - If you work for this employer in more than                CHANGES IN EXEMPTIONS - You should file a new certificate at 
two cities or communities, print names of the two Michigan cities               any time if the number of your exemptions INCREASES. 
or  communities  where  you  perform the  greatest  percent of  your             
work. Circle the closest percent of total earnings for work done or             You  must  file  a  new  certificate  within  1O  days  if  the  number  of 
services rendered in each city or community listed. The estimated               exemptions previously claimed by you DECREASES for any of the 
percent of total earnings from the employer for work done or services           following reasons: 
performed within taxing cities (line 3 on other side) is for withholding         Your  wife  (or  husband)  for  whom  you   have    been  claiming 
purposes  only In . determining  final  tax  liability  this  estimate is            exemption is divorced or legally separated, or claims her (or 
subject to substantiation and audit.                                                 his) own exemption on a separate certificate. 
                                                                                 The support of a dependent for whom you claimed exemption  is 
DEPENDENTS - To qualify as your dependent (line 6 on other side),                    taken over by someone else, so that you no longer expect to 
a person (a) must receive more than one-half of his or her support                   furnish more than half the support for the year. 
from you for the year, and (b) must have less than $600 gross income             You find that a dependent for whom you claimed exemption will 
during the year (except your  child who is  a student or who is under                receive $600 or more of income of his own during the year 
19 years  of  age), and (c) must not be claimed as an exemption by                   (except your child who is a student who is under 19 years of 
such person's  husband  or  wife, and (d) must be a citizen or resident              age). 
of the United States or a resident of Canada, Mexico, the Republic of            
Panama or the Canal Zone (this does not apply to an alien child legally         OTHER DECREASES in exemption such as the death of a wife or a 
adopted by and living with a United States citizen abroad), and (e)             dependent,  do  not  affect  your  withholding  until  the  next  year,  but 
must (1) have your home as his principal residence and be a member              require the filing of a new certificate by December 1 of the  year in 
of  your  household  for  the  entire  year,  or  (2)  be  related  to  you  as which they occur. 
follows:                                                                         
 Your  son  or  daughter  (including  legally  adopted  children),              CHANGE OF RESIDENCE - You must file a new certificate within 10 
        grandchild,  stepson,  stepdaughter,  son-in-   law,  or  daughter-     days after you change your residence from or to a taxing city. 
        in-law;                                                                  
 Your father, mother, grandparent, stepfather, stepmother, father-              CHANGES IN EMPLOYMENT - You must file a new certificate by 
        in-law, or mother-in-law;                                               December 1 of each year if your Line 3 estimate of the percent of 
 Your  brother,  sister,  stepbrother,  stepsister,  half  brother,  half       work done or services to be rendered in cities levying an income tax 
        sister, brother-in-law, or sister-in-law;                               will change for the ensuing year. 
 Your uncle, aunt, nephew, or niece (but only if related by blood).