K-4 
                                                               KANSAS                                                                                                       Attach
K-4(Rev. 7-24)                                                                                                                                                              500524
                      EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE

Use the following instructions to accurately      STATE  income tax  withheld because you          employer. If your employer does not receive 
complete  your  K-4  form,  then  detach  the     had no tax liability; and  2)this year you will  a K-4 form from you, they must withhold 
lower portion and give it to your employer.       receive a full refund of all STATE income        Kansas income tax from your wages without 
For assistance, call the Kansas Department        tax withheld because you will have       no tax  exemption at the “Single” allowance rate.
of Revenue at 785-368-8222.                       liability.                                       Head of household:                                               Generally,  you may 
Purpose  of  the  K-4 form:  A  completed         Basic Instructions:   If you are not exempt,     claim  head  of  household  filing  status  on 
withholding allowance certificate will let your   complete the Personal Allowance  Worksheet       your tax  return only if  you are                                              unmarried 
employer know how much      Kansas income         that follows. The total on line F should not     and pay more than 50%  of the cost of 
tax  should be withheld from  your pay on         exceed the total exemptions you claim            keeping up a home for yourself and for 
income you earn from Kansas sources.              under “Exemptions and Dependents” on             your dependent(s).
Because your tax  situation may  change,          your Kansas income tax return.                   Non-wage income:                                                 If you have a large 
you may want to re-figure your withholding        NOTE: Your status of “Single” or “Joint”         amount of non-wage Kansas source income, 
each year.                                        may differ from your status claimed on your      such  as  interest  or  dividends,  consider 
Exemption from Kansas withholding: To             federal form W-4).                               making Kansas estimated tax payments on 
qualify for exempt status you must verify with    Using the information from your       Personal   Form K-40ES. Without these payments, you 
the Kansas Department of Revenue that:   1)       Allowance Worksheet, complete the           K-4  may  owe  additional  Kansas  tax  when  you 
last year you had the right to a refund of all    form below, sign it and provide it to your       file your state income tax return.

                                       Personal Allowance Worksheet (Keep for your records)

A  Allowance Rate:  If you are a single filer mark “Single”                                                                                                         A       o Single
                     If you are married and your spouse has income mark “Single”                                                                                            o Joint
                     If you are married and your spouse does not have income mark “Joint”
B  Enter “0” or “1” if you are married or single(entering “0” may help you avoid having too little tax withheld) ..................   B                                     __________________
C  Enter “0” or “1” if you are married and only have one job, and your spouse does not work (entering “0” may help
   you avoid having too little tax withheld) .........................................................................................................................   C  __________________
D. Enter “2” if you will file head of household on your tax return (see conditions under Head of Household above) ..........                                        D       __________________
E  Enter the number of dependents you will claim on your tax return. Do not claim yourself or your spouse or
   dependents that your spouse has already claimed on their form K-4 ............................................................................   E                       __________________
F Add lines B through E  and enter the total here ........................................................................................................... F             __________________

                      Cut here and give the lower portion to your employer. Keep the top portion for your records. 

                     Kansas Employee’s Withholding Allowance Certificate
K-4(Rev. 7-24)  Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the
                Kansas Department of Revenue. Your employer may be required to send a copy of this form to the Department of Revenue.

   1  Print your First Name and Middle Initial                        Last Name                                                              2  Social Security Number

      Mailing address                                                                      3 Allowance Rate
                                                                                            Mark the allowance rate selected in Line A above.
                                                                                                   o       Single                                      o            Joint

   4  Total number of allowances you are claiming (from Line F above) ...............................................................................  4
   5  Enter any additional amount you want withheld from each paycheck (this is optional) .................................................            5 $
   6  I claim exemption from withholding. (You must meet the conditions explained in the “Exemption from withholding” 
      instructions above.) If you meet the conditions above, write “Exempt” on this line .......................................................       6
      Note: The Kansas Department of Revenue will receive your federal W-2 forms for all years claimed Exempt.
   Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief it is true, correct, and complete.
   SIGN
   HERE                                                                                                                                      Date
   7  Employer’s Name and Address                                                                                                            8  EIN (Employer ID Number)