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GRW-4 RESIDENT
EMPLOYEE’S WITHHOLDING CERTIFICATE FOR GRAND RAPIDS INCOME TAX NONRESIDENT
1. Print Full Name Social Security No. Office, Plant, Dept. Employee Identification No
2. Address, Number and Street City, Township or Village where you reside State Postal Code
3. Place of Employment City Under 40% 60% 80% 100%
25 %
Print name of each city where you work for this City
employer and circle closest % of total earnings in each. Under 40% 60% 80% 100%
25%
YOUR Check 4. Exemptions Regular Additional exemption if Additional Enter number of exemptions
WITHHOLDING blocks for yourself exemption 65 or over at end of year Exemption if blind checked
EXEMPTIONS which 5. Exemptions Regular Additional exemption if Additional Enter number of exemptions
apply for your spouse exemption 65 or over at end of year Exemption if blind checked
EMPLOYEE: File this form with your 6. (a) Exemptions for your children: Number 6. (b) Exemptions for your Number Enter total of line 6
employer. Otherwise they must withhold other dependents: (a plus b)
GRAND RAPIDS income tax from your
earnings without exemption. 7. Add the number of exemptions which you have claimed on line 4, 5 and 6 above and write the total
EMPLOYER: Keep this certificate with your I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief
records. If the information submitted by the Signature
employee is not believed to be true, correct 8. Date
and complete, the CITY INCOME TAX
DEPARTMENT must be so advised.
To answer residency questions call the SEE INSTRUCTIONS
Income Tax Department at (616) 456-3415. Revised 7/2004
INSTRUCTIONS FOR COMPLETING EMPLOYEE’S WITHHOLDING CERTIFICATE FOR GRAND RAPIDS INCOME TAX
FORM GRW-4
GENERAL INSTRUCTIONS—Check the box in the INCREASE IN EXEMPTIONS—You should file a new
upper right hand corner to indicate your residency certificate at any time if the number of your exemptions
status and enter the requested data on lines 1 and 2. increases.
LINE 3 INSTRUCTIONS—If you are a nonresident and DECREASE IN EXEMPTIONS—
work for this employer in two or more cities or 1. You must file a new certificate within 10 days if the
communities, print the names of the two Michigan number of exemptions previously claimed by you
cities or communities where you perform the greatest DECREASES for any of the following reasons:
percentage of your work. Circle the closest percent of (a) Your spouse for whom you have been claiming
total earnings for work done or services rendered in exemption is divorced or legally separated, or
each city or community listed. The estimated percent claims their own exemption on a separate
of total earnings from this employer for work done or certificate.
services performed within taxing cities (Line 3) is for (b) The support of a dependent for whom you
withholding purposes only. In determining final tax claimed exemption is taken over by someone
liability this estimate is subject to substantiation and else, so that you no longer expect to furnish
audit. more than half of their support for the year.
DEPENDENTS—To qualify as your dependent (line 6), (c) You find that a dependent for whom you
a person (a) must receive more than one-half of his or claimed an exemption will receive $3,000 or
her support from you for the year, and (b) must have more of income of their own during the year.
less than $3,000 gross income during the year (except 2. CHILD TURNS 19—File a new certificate within 10
your child who is under 19 years of age or who is a full- days of the start of the tax year in which your child,
time student under 24 years of age), and (c) must not for whom you claimed exemption, turns 19 years of
be claimed as an exemption by such person’s husband age or, if a full- time student, 24 years of age.
or wife, and (d) must be a citizen or resident of the 3. DEATH OF SPOUSE OR DEPENDENT—You
United States or a resident of Canada, Mexico, the must file a new certificate by December 1 of the
Republic of Panama or the Canal Zone (this does not year in which the death of your spouse or
apply to an alien child legally adopted by and living dependent for whom you claimed exemption
with a United States citizen abroad), and (e) must (1) occurs. (Death of a spouse or a dependent does
have your home as his principal residence and be a not affect your withholding until the next year.)
member of your household for the entire year, or (2) be 4. CHANGE OF RESIDENCE—You must file a new
related to you as follows: certificate within 10 days after you change your
• Your son or daughter (including legally adopted residence from or to a taxing city.
children), grandchild, stepson, stepdaughter, son- 5. CHANGE IN EMPLOYMENT—You must file a new
in-law, or daughter-in-law. certificate by December 1 each year if your
• Your father, mother, grandparent, stepfather, estimate of the percentage of work done or
stepmother, father-in-law, or mother-in-law. services rendered in Grand Rapids (Line 3) will
• Your brother, sister, stepbrother, stepsister, half change for the ensuing year.
brother, half sister, brother-in-law, or sister-in-law. EXTRA EXEMPTIONS—Additional exemptions
• Your uncle, aunt, nephew, or niece (but only if allowed for federal income tax purposes and claimed
related by blood). on Schedule A of federal Form W-4 are not allowed for
Grand Rapids income tax purposes.
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