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AR4EC STATE OF ARKANSAS
Employee’s Withholding Exemption Certificate
Print Full Name Social Security Number
Print Home Address City State Zip
How to Claim Your Withholding Number of Exemptions
See instructions below Claimed
Employee:
File this form with 1. CHECK ONE OF THE FOLLOWING FOR EXEMPTIONS CLAIMED
your employer.
a. You claim yourself. (Enter one exemption) ......................................................................1a
Otherwise, your
employer must b. You claim yourself and your spouse. (Enter two exemptions) .........................................1b
withhold state c. Head of Household, and you claim yourself. (Enter two exemptions) .............................1c
income tax from
your wages without 2. NUMBER OF CHILDREN or DEPENDENTS. (Enter one exemption per dependent) ................. 2
exemptions or
dependents. 3. TOTAL EXEMPTIONS. (Add Lines 1a, b, c, and 2)
If no exemptions or dependents are claimed, enter zero.............................................................. 3
Employer:
Keep this certificate 4. Additional amount, if any, you want deducted from each paycheck. (Enter dollar amount) ......... 4
with your records.
5. I qualify for the low-income tax rates. (See below for details) ....................................................... 5 Yes No
Please check filing status: Single Married Filing Jointly Head of Household
I certify that the number of exemptions and dependents claimed on this certificate does not exceed the number to which I am entitled.
Signature: Date:
Instructions
TYPES OF INCOME - This form can be used for withholding on all types (a) Your spouse for whom you have been claiming an
of income, including pensions and annuities. exemption is divorced or legally separated from you, or claims
his or her own exemption on a separate certificate, or
NUMBER OF EXEMPTIONS – (Husband and/or Wife) Do not claim more (b) The support you provide to a dependent for whom you claimed
than the correct number of exemptions. However, if you expect to owe more an exemption is expected to be less than half of the total support for the year.
income tax for the year, you may increase your withholding by claiming a OTHER DECREASES in exemptions or dependents, such as the death of a
smaller number of exemptions and/or dependents, or you may enter into an spouse or a dependent, does not affect your withholding until next year, but
agreement with your employer to have additional amounts withheld. This is requires the filing of a new certificate by December 1 of the year in which
especially important if you have more than one employer, or if both husband they occur.
and wife are employed.
You may claim additional amounts of withholding tax if desired. This will
DEPENDENTS – To qualify as your dependent (line 2 of form), a person apply most often when you have income other than wages.
must (a) receive more than 1/2 of their support from you for the year, (b)
not be claimed as a dependent by such person’s spouse, (c) be a citizen You qualify for the low-income tax rates if your total income from all
or resident of the United States, and (d) have your home as their principal sources is:
residence and be a member of your household for the entire year or be
(a) Single $1 ,3 447 to $16,000
related to you as follows: son, daughter, grandchild, stepson, stepdaughter, (b) Married Filing Jointly $2 ,2 676 to $26,700
son-in-law or daughter-in-law; your father, mother, grandparent, stepfather, (1 or less dependents)
stepmother, father-in-law or mother-in-law; your brother, sister, stepbrother, (c) Married Filing Jointly $2 ,7 292 to $3 , 00 3 1
(2 or more dependents)
stepsister, half-brother, half-sister, brother-in-law or sister-in-law; your uncle, (d) Head of Household/Qualifying Widow(er) $19,118 to $2 , 00l 3 3
aunt, nephew or niece (but only if related by blood). (1 or less dependents)
(e) Head of Household/Qualifying Widow(er) $2 ,2 790 to $2 , 00 6 6
(2 or more dependents)
CHANGES IN EXEMPTIONS OR DEPENDENTS – You may file
a new certificate at any time if the number of exemptions or dependents
For additional information consult your employer or write to:
INCREASES. You must file a new certificate within 10 days if the number Arkansas Withholding Tax Section
of exemptions or dependents previously claimed by you DECREASES for P. O. Box 8055
any of the following reasons: Little Rock, Arkansas 72203-8055
AR4EC (R 1 /1 16/202 )2
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