FORM SD/W-4A                                                           Reset       Print Form
                                   STATE OF DELAWARE
   WITHHOLDINGALLOWANCE(S) COMPUTATION WORKSHEET
                                              
A. Enter “1” for Yourself (2 if 60 years old or older)               A. __________ 
   if no one else claims you as a dependent. 

B. Enter “1” for your Spouse (2 if 60 years or older)                B. __________ 
   if no one else claims your spouse as a dependent. 

C. Enter number of dependents other than your spouse that            C. __________ 
   you will claim. 

D. Enter “1” if you qualify to take a child/dependent care           D. __________ 
   credit for one child or dependent and “2” if you qualify 
   to take the credit for two or more children or dependents. 

E. Enter “1” for yourself if 65 or over and “1” if blind.            E. __________ 

F. Enter “1” for spouse if 65 or over and “1” if blind.              F. __________ 

G. Add Line A through F and enter total here.                        G. __________ 

If you plan to itemize or receive non-wage income, or claim other deductions and wish to adjust your 
withholding, continue with the following Section H. OTHERWISE STOP HERE and enter number from 
Line G onto Form W-4 and indicate “For Delaware Purposes Only”.

H. DEDUCTIONS AND INCOME ADJUSTMENTS – 
   NOTE– Use this section only if you plan to 
   Itemize or claim other deductions or have non-
   Wage income. If computing this section on married 
   filing separate or combined separate status, the 
   following rule applies: include only the amount of 
   itemized deductions that pertain to your separate return. 

1. Enter an estimate of your itemized deductions               1. $ __________ 
   for the current year, i.e. home mortgage interest, 
   real estate and other taxes (excluding state income 
   tax paid), charitable contributions, medical expenses 
   in excess of 7.5% of adjusted gross income, and 
   miscellaneous deductions (most miscellaneous 
   deductions are now deductible only in excess of 2% 
   of your adjusted gross income). 

2. Delaware Standard Deduction of $3,250                       2.  $   3,250.00 

                                                               *DF40913019999*

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3. Subtract Line 2 from Line 1, but not less than zero.           3. $__________

4. Enter an estimate of your subtraction adjustment to            4. $__________
   income for the current year. These include alimony paid, 
   IRA contributions, State pension exclusion and the 
   Exclusion for certain persons over 60 years old or 
   Disabled.

5. Add Lines 3 and 4.                                             5. $__________

6. Enter an estimate of your non-wage income for the              6. $__________
   current year. 

7. Subtract Line 6 From Line 5 and enter the result.              7. $__________

8. Divide the amount on Line 7 by $2,000 and enter result         8.   __________
   here. Round down to nearest whole number. 

9. Enter the number from Line G above.                            9.   __________

10. Add Lines 8 and 9 and enter total here.                       10.  __________
   IF LESS THAN ZERO, SEE SPECIAL INSTRUCTIONS 
   BELOW*. Report this number of allowances on 
   Form W-4 and indicate “For Delaware Purposes Only” 
   to your employer. 

I. *SPECIAL INSTRUCTIONS:          If the total on Line 10 is less than zero you will need additional 
   withholding as a result of non-wage income. You can calculate the amount of additional
   withholding as follows: 

   (1) Multiply number on Line 10 by $110; 

   (2) Divide the result by the number of pay periods 
   during the year (e.g. if you are paid monthly, 
   divide by 12); The result is the additional amount 
   of withholding required per pay. 

EXAMPLE: Total on Line 10 is “-2” and you are paid once a month. 

   (1) Line H = 2 x $110 = $220.00

   (2) Number of pay periods = $220.00/12 = $18.33 

You should notify your employer on a “ For Delaware Purposes Only ” W-4 that withholding 
allowance should be “0” and an additional $18.33 per pay should be withheld for the current year. 

  Revised 01/28/13                                                *DF40913029999*

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