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Indiana Wh 4 Sample

Form WH-4

State Form 48845 (R10 / 8-23)

State of Indiana

Employee’s Withholding Exemption and County Status Certificate

This form is for the employer’s records. Do not send this form to the Department of Revenue.

The completed form should be returned to your employer.

Full Name_ _______________________________________________________ Social Security Number or ITIN___________________________

Home Address_________________________________ City_______________________ State_______

ZIP Code_______________________

 

Indiana County of Residence as of January 1:_________________________________________

(See instructions)

 

 

 

 

Indiana County of Principal Employment as of January 1:________________________________

(See instructions)

 

 

 

 

Check this box if the changes to the counties are effective for the next calendar year. (See instructions)

 

 

 

_____________________________________________________________________________________________________________________________________

 

How to Claim Your Withholding Exemptions

 

 

 

 

1.

You are entitled to one exemption. If you wish to claim the exemption, enter “1”

___________

 

 

Nonresident aliens must skip lines 2 through 8. See instructions

 

 

 

 

2.

If you are married and your spouse does not claim his/her exemption, you may claim it, enter “1”

___________

 

3.

You are allowed one (1) exemption for each dependent. Enter number claimed

___________

 

4.

Additional exemptions are allowed if: (a) you and/or your spouse are over the age of 65 and/or

 

 

 

 

 

(b) if you and/or your spouse are legally blind.

 

 

 

 

 

Check box(es) for additional exemptions: You are 65 or older or blind Spouse is 65 or older or blind

 

 

 

 

Enter the total number of boxes checked

___________

 

 

 

 

 

 

5.

Add lines 1, 2, 3, and 4. Enter the total here

 

 

 

 

 

 

6.

You are entitled to claim an additional exemption for each qualifying dependent (see instructions)

 

 

7.

You are entitled to claim an additional exemption for each qualifying dependent claimed for the first time (see instructions)

 

 

 

 

 

 

 

8.

.................................You are entitled to claim an additional exemption for each adopted qualifying dependent (see instructions)

 

 

9.

Enter the amount of additional state withholding (if any) you want withheld each pay period

$__________

 

10.

Enter the amount of additional county withholding (if any) you want withheld each pay period

$__________

 

 

I hereby declare that to the best of my knowledge the above statements are true.

 

 

 

 

Signature:_ ______________________________________________________________________

Date:___________________________

Instructions for Completing Form WH-4

This form should be completed by all resident and nonresident employees having income subject to Indiana state and/or county income tax.

Print or type your full name, Social Security number or ITIN and home address. Enter your Indiana county of residence and county of principal employment as of January 1 of the current year. If you neither lived nor worked in Indiana on January 1 of the current year, enter ‘not applicable’ on the line(s). If you move to (or work in) another county after January 1, your county status will not change until the next calendar year. Please check the box if you are requesting a change to a county of residence or work for the next calendar year.

Nonresident alien limitation. A nonresident alien is allowed to claim only one exemption for withholding tax purposes. If you are a nonresident alien, enter “1” on line 1, then skip to line 9. You are considered to be a nonresident alien if you are not a citizen of the United States and do not meet the green card test and the substantial presence test (get Publication 519 from www.irs.gov for information about these tests).

All other employees should complete lines 1 through 8.

Lines 1 & 2 - You are allowed to claim one exemption for yourself and one for your spouse (if he/she does not claim the exemption for him/herself). If a parent or legal guardian claims you on their federal tax return, you may still claim an exemption for yourself for Indiana purposes. You cannot claim more than the correct number of exemptions; however, you are permitted to claim a lesser number of exemptions if you wish additional withholding to be deducted.

Line 3 - Dependent Exemptions: You are allowed one exemption for each of your dependents based on state guidelines. To qualify as your dependent, a person must receive more than one-half of his/her support from you for the tax year and must have less than $4,400 gross income during the tax year (unless the person is your child and either (1) is under age 19 or (2) is under age 24 and a full-time student at a qualified educational institution during at least 5 months of the tax year).

Line 4 - Additional Exemptions. You are also allowed one exemption each for you and/or your spouse if either is 65 or older and/or blind. Line 5 - Add the total of exemptions claimed on lines 1, 2, 3, and 4. Enter the total in the box provided.

Line 6 - Additional Dependent Exemptions. An additional exemption is allowed for certain dependent children that are included on line 3. The dependent child must be a son, stepson, daughter, stepdaughter, foster child, and/or child for whom you are a legal guardian. The dependent must be under age 19 or must be both under age 24 and a full-time student at a qualified educational institution during at least 5 months of the taxable year.

Line 7 - First-time Claimed Additional Exemption. If an additional dependent exemption on Line 6 is being claimed for one or more children for the first time, enter the number of children for whom you are claiming. This exemption is good only for the calendar year in which the WH-4 claiming the exemption is submitted. If you claim this in multiple tax years, you MUST submit a new WH-4 each year for which this exemption is claimed. Do not claim this exemption if the child was eligible for the additional dependent exemption in any previous year, regardless of whether the exemption was claimed. This includes instances where the child was eligible for the additional dependent exemption before 2023. This also includes instances where the child was eligible to be claimed for the additional dependent exemption by another individual.

Line 8 - Additional Adopted Dependent Exemptions. An additional exemption is allowed for certain dependent children that are included on lines 3 and 6 and have been adopted by you or your spouse. The dependent child must be a son, stepson, daughter, or stepdaughter. The dependent must be under age 19 or must be both under age 24 and a full- time student at a qualified educational institution during at least 5 months of the taxable year.

Lines 9 & 10 - If you would like an additional amount to be withheld from your wages each pay period, enter the amount on the line provided. NOTE: An entry on this line does not obligate your employer to withhold the amount. You are still liable for any additional taxes due at the end of the tax year. If the employer does withhold the additional amount, it should be submitted along with the regular state and county tax withholding.

You may file a new Form WH-4 at any time if the number of exemptions increases. You must file a new Form WH-4 within 10 days if the number of exemptions previously claimed by you decreases for any of the following reasons:

(a)you divorce (or are legally separated from) your spouse for whom you have been claiming an exemption or your spouse claims him/herself on a separate Form WH-4;

(b)someone else takes over the support of a dependent you claim or you no longer provide more than one-half of the person’s support for the tax year; or

(c)a dependent no longer qualifies for an additional dependent or an adopted dependent exemption.

Penalties are imposed for willingly supplying false information or information which would reduce the withholding exemption.

File Characteristics

Fact Name Details
Purpose The Indiana WH-4 form is used to determine an employee's withholding exemptions for state and county income tax.
Who Should Complete It All resident and nonresident employees with income subject to Indiana income tax must complete this form.
Exemption Claims Employees can claim one exemption for themselves, one for a spouse, and additional exemptions for dependents and certain conditions.
Filing Instructions Do not send the completed form to the Department of Revenue. Return it to your employer for their records.
Governing Law This form is governed by Indiana state tax laws, specifically the Indiana Code Title 6, Article 3.

Essential Points on This Form

What is the purpose of the Indiana WH-4 form?

The Indiana WH-4 form is an Employee’s Withholding Exemption and County Status Certificate. It is used to inform your employer about your withholding exemptions and the county where you reside and work. This form helps your employer determine the correct amount of state and county income tax to withhold from your paychecks. It is important to note that this form should not be sent to the Department of Revenue; instead, it should be returned directly to your employer.

Who needs to complete the Indiana WH-4 form?

All resident and nonresident employees with income subject to Indiana state and/or county income tax must complete the Indiana WH-4 form. This includes individuals who live or work in Indiana as of January 1 of the current year. If you neither lived nor worked in Indiana on that date, you should indicate 'not applicable' on the appropriate lines. Nonresident aliens have specific limitations and should only claim one exemption for withholding tax purposes.

How do I determine the number of exemptions I can claim?

To determine the number of exemptions you can claim, follow these guidelines:

  1. You are entitled to one exemption for yourself.
  2. If you are married and your spouse does not claim their exemption, you can claim one for them.
  3. You can claim one exemption for each dependent you support.
  4. If you or your spouse are 65 or older or legally blind, you can claim additional exemptions.

After identifying your exemptions, add them together and enter the total on the designated line of the form. Remember, you can choose to claim fewer exemptions if you prefer higher withholding.

What should I do if my circumstances change?

If your circumstances change, such as a divorce or a change in dependent status, you must file a new Indiana WH-4 form. You should do this within 10 days if the number of exemptions you claim decreases. Additionally, you can file a new form at any time if your exemptions increase. Keep in mind that providing false information can lead to penalties, so ensure that all information submitted is accurate.

Misconceptions

Here are six common misconceptions about the Indiana WH-4 form:

  • Misconception 1: The WH-4 form must be sent to the Department of Revenue.
  • This is incorrect. The WH-4 form is for your employer's records only. You should return it directly to your employer, not the Department of Revenue.

  • Misconception 2: Nonresident aliens can claim multiple exemptions.
  • Nonresident aliens are limited to claiming only one exemption for withholding tax purposes. They should enter “1” on line 1 and skip to line 7.

  • Misconception 3: You can change your county status anytime during the year.
  • Your county status is fixed as of January 1. If you move after that date, your status will not change until the next tax year.

  • Misconception 4: You must claim all exemptions you are eligible for.
  • You are not required to claim all eligible exemptions. You can choose to claim fewer exemptions if you prefer additional withholding from your paycheck.

  • Misconception 5: Completing the WH-4 form guarantees that your employer will withhold the desired amount.
  • Entering an amount for additional withholding does not obligate your employer to withhold that amount. You remain responsible for any taxes due at the end of the year.

  • Misconception 6: You don’t need to file a new WH-4 form if your circumstances change.
  • You must file a new WH-4 within 10 days if your number of exemptions decreases due to events like divorce or changes in dependent support.