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Virginia W4

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Submitted By tygamann1
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FORM VA-4

COMMONWEALTH OF VIRGINIA
DEPARTMENT OF TAXATION

PERSONAL EXEMPTION WORKSHEET
(See back for instructions)

1
1. you wish to claim yourself, write “1”............................................................... ________________
If
2. you are married and your spouse is not claimed
If
0 n his or her own certificate, write “1”................................................................ ________________ o 3.
Write the number of dependents you will be allowed to claim
0
your income tax return (do not include your spouse).................................... ________________ on 1
4.
Subtotal Personal Exemptions (add lines 1 through 3)...................................... ________________
5.
Exemptions for age
0
(a)
I
_f you will be 65 or older on January 1, write “1”................................... ________________ (b)
I
_f you claimed an exemption on line 2 and your spouse
0

w
_ ill be 65 or older on January 1, write “1”............................................. ________________
6.
Exemptions for blindness
0
(a)
I
_f you are legally blind, write “1”............................................................ ________________ (b)
I
_f you claimed an exemption on line 2 and your
0

s
_ pouse is legally blind, write “1”............................................................ ________________
0
7.
Subtotal exemptions for age and blindness (add lines 5 through 6)...................................................._______________
1
8.
Total of Exemptions - add line 4 and line 7.........................................................................................._______________

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

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