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Instructions and a worksheet for employees in the commonwealth of virginia to determine and claim their personal income tax exemptions. The worksheet includes lines for claiming exemptions for oneself, spouse, dependents, age, and blindness. The instructions outline the conditions for claiming exemptions and the process for filing the form with an employer.
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Detach here and give the certificate to your employer. Keep the top portion for your records FORM VA-4 EMPLOYEE’S VIRGINIA INCOME TAX WITHHOLDING EXEMPTION CERTIFICATE
EMPLOYER: Keep exemption certificates with your records. If you believe the employee has claimed too many exemptions, notify the Department of Taxation, P.O. Box 1 115 , Richmond, Virginia 232 18 - 1115 , telephone (804) 367-8037.
Signature (^) Date
VA DEPT OF TAXATION 2601064 REV 10/
FORM VA- INSTRUCTIONS Use this form to notify your employer whether you are subject to Virginia income tax withholding and how many exemptions you are allowed to claim. You must file this form with your employer when your employment begins. If you do not file this form, your employer must withhold Virginia income tax as if you had no exemptions. PERSONAL EXEMPTION WORKSHEET You may not claim more personal exemptions on form VA-4 than you are allowed to claim on your income tax return unless you have received written permission to do so from the Department of Taxation. Line 1. You may claim an exemption for yourself. Line 2. You may claim an exemption for your spouse if he or she is not already claimed on his or her own certificate. Line 3. Enter the number of dependents you are allowed to claim on your income tax return. NOTE: A spouse is not a dependent. Line 5. If you will be age 65 or over by January 1, you may claim one exemption on Line 5(a). If you claim an exemption for your spouse on Line 2, and your spouse will also be age 65 or over by January 1, you may claim an additional exemption on Line 5(b). Line 6. If you are legally blind, you may claim an exemption on Line 6(a). If you claimed an exemption for your spouse on Line 2, and your spouse is legally blind, you may claim an exemption on Line 6(b). FORM VA- Be sure to enter your social security number, name and address in the spaces provided. Line 1. If you are subject to withholding, enter the number of exemptions from: (a) Subtotal of Personal Exemptions - line 4 of the Personal Exemption Worksheet (b) Subtotal of Exemptions for Age and Blindness - line 7 of the Personal Exemption Worksheet (c) Total Exemptions - line 8 of the Personal Exemption Worksheet Line 2. If you wish to have additional tax withheld, and your employer has agreed to do so, enter the amount of additional tax on this line. Line 3. If you are not subject to Virginia withholding, check the box on this line. You are not subject to withholding if you meet any one of the conditions listed below. Form VA-4 must be filed with your employer for each calendar year for which you claim exemption from Virginia withholding. (a) You had no liability for Virginia income tax last year and you do not expect to have any liability for this year. (b) You expect your Virginia adjusted gross income to be less than:
(c) You live in Kentucky or the District of Columbia and commute on a daily basis to your place of employment in Virginia. (d) You are a domiciliary or legal resident of Maryland, Pennsylvania or West Virginia whose only Virginia source income is from salaries and wages and such salaries and wages are subject to income taxation by your state of domicile.
Prior to 1/1/2005 On or After 1/1/ Single (^) $5,000 Single $ 7 , 0 0 0 Married, filing a joint orcombined return $8,000 Married, filing a joint orcombined return $ 1 4 , 0 0 0 Married, filing a separate return $4,^ Married, filing a separate return $ 7 , 0 0 0