GR W-4 Employee's Withholding Certificate For City of Grayling D RESIDENT
Income Tax D NON-RESIDENT
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 'Zip Code
3. Predominant Place of Employment City Under
Print name of each city where you work for this 25% 40% 60% 80% 100%
employer and circle closest % of total earnings City Under
in each. 25% 40% 60% 80% 100%
YOUR WITHHOLDING Che°' 4. Exemptions Regular S3000 Additional S3,000 exemption if Additional S3,000 Enter number ol
EXEMPTIONS: blocks for yourself exemption 65 or over at end of year □ exemption if blind e1<emptJOns
checked_..
(See instructions on which } 5. Exemptions □ Regular S3000 □ Additional S3,000 exemption if Additional S3,000 Enler number of
exemptions
reverse side.) apply for your wife (h.Jsbard) exemption 65 or over at end of year exemption if blind checked_..
EMPLOYEE: File this form with your employer. 6. (a) Exemptions for your □ □ □ Number Enter total
Number , 6. (b) Exemptions for your of line 6
Otherwise he must withhold CITY OF children other dependents (aplusb)_.
GRAYLING income tax from your earnings with-
out exemption. Add the number of exemptions which you have claimed on lines 4,5 and 6 above and write the total I I
7.
EMPLOYER: keep this certificate with your
records. If the information submitted by lhe I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
employee is not believed to be,lrue correct and
complele. The City Treasurer must be so 8. Date Signature
advised. 20 I
GR W-4 Employee's Withholding Certificate For City of Grayling D RESIDENT
Income Tax D NON-RESIDENT
1. Print Full Name Social Security No. Ottice, Plant Dept. Employee Identification No.
2. Address, Number and Street City, Township or Village where you reside State 'Zip Code
3. Predominant Place of Employment City Under
Print name of each city where you work for this 25% 40% 60% 80% 100%
employer and circle closest % of total earnings City Under
in each. 25% 40% 60% 80% 100%
YOUR WITHHOLDING 4. Exemptions Regular S3000 Additional $3,000 exemption if Additional S3,000 Enter number ol
exempt10ns
EXEMPTIONS: blocks for yourself exemption 65 or over at end of year exemption if blind checked_.,.
(See instructions on c-which 5. Exemptions □Regular $3000 □ □ Enter number of
Additional S3,000 exemption if Additional S3,000
reverse side.) apply exemptions
} for your wife (husbard) exemption 65 or over at end of year exemption if blind checked___,..
EMPLOYEE: File this form with your employer. 6. (a) Exemptions for your □Number , 6. (b) Exemptions for your □ □ Number Enler total
ol 11ne 6
Otherwise he must withhold CITY OF children other dependents (aplusb)_.
GRAYLING income tax from your earnings wilh-
out exemption. 7. Add the number of exemptions which you have claimed on lines 4 ,5 and 6 above and write the total I I
EMPLOYER: keep this certificate wilh your
records. If the information submitled by the I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
employee is not believed to be true, correct and
complete. The City Treasurer must be so 8. Date Signature
advised. 20 I
GR W-4 Employee's Withholding Certificate For City of Grayling D RESIDENT
Income Tax D NON-RESIDENT
1. Print Full Name Social Security No. Ottice, Plant Dept. Employee Identification No.
2. Address, Number and Street City, Township or Village where you reside State 'Zip Code
3. Predominant Place of Employment City Under
Print name of each city where you work for this 25% 40% 60% 80% 100%
employer and circle closest % of total earnings City Under
in each. 25% 40% 60% 80% 100%
YOUR WITHHOLDI NG Ch�' 4. Exemptions Regular $3000 Additional $3,000 exemption if Additional $3,000 Enter number ol
EXEMPTIONS: blocks for yourself exemption 65 or over at end of year exemption if blind e.:empt10ns
□ checked_..
(See instructions on which } 5. Exemptions □ Regular $3000 □ Additional S3,000 exemption if Additional $3,000 Enter number ol
exemptions
reverse side.) apply for your wife (husbard) exemption 65 or over at end of year exemption if blind checked _.
EMPLOYEE: File this form with your employer. 6. (a) Exemptions for your □Number , 6. (b) Exemptions for your □ □ Number Enter IOlal
Otherwise he must withhold CITY OF children other dependents of line 6
GRAYLING income tax from your earnings with- (aplusb)_.
out exemption. I I
7. Add the number of exemptions which you have claimed on lines 4,5 and 6 above and write the total -
EMPLOYER: keep this certificate with your
records. If the information submitled by lhe I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
employee is not believed to be true, correct and
complete. The City Treasurer must be so 8. Date Signature
advised. 20
I