Vermont Department of Taxes

          Employee’s Withholding Allowance Certificate - Form W-4VT

                         All Vermont employees should complete this form.
                         To be filed with your employer.

Last Name                               First Name                                               Initial Social Security Number

Filing Status - Check ONE
                         Married/Civil Union               Married/Civil Union                               Married, but withhold 
          Single
                         Filing Jointly                    Filing Separately                                 at higher single rate

                         Vermont Allowances Worksheet

  1.  Enter “1” for yourself if no one can claim you as a dependent. . . . . . . . . . . . . . . . . . 1. ___________

  2. Enter “1” if you are filing jointly and your spouse does not work ............... 2. ___________

  3. Enter the number of dependents you plan to claim on your tax return.  If you file 
     jointly, then only one of you should claim the dependents on your W-4VT ....... 3. ___________

  4. Enter “1” if you plan to file as “head of household”. . . . . . . . . . . . . . . . . . . . . . . . . . 4. ___________

  5. Total number of Vermont allowances.  (Add Lines 1 through 4 and enter total here.) ............ 5.  ___________

  6. Enter an additional amount, if any, you want withheld from each check. ...................... 6.  ___________

Exempt:  If you had a right to a refund of all your Vermont income tax withheld last year because you 
     had no tax liability and you also expect to have no liability this year, write “Exempt” here.  .......   ____________

                                        General Information
Form W-4VT is designed so that you can have as much “take-home pay” as possible without an income tax liability due to 
Vermont when you file your tax return.  Each withholding allowance you claim on Line 5 above will reduce the amount of 
income you are taxed on and therefore the amount of Vermont income tax withheld each paycheck.
Here are some things to remember as you complete this form:
     •    Generally, dependents are children under 19 (or up to 24 if they are a full-time student) and any relatives who 
          live with you and you support financially.
     •    If you and your spouse both claim your dependents on your respective W-4VTs, not enough income tax will be 
          withheld, and you might end up with taxes due when you file.  Only one spouse should claim the dependents.
     •    If you entered an additional amount to be withheld on the federal W-4, consider entering 30% of that amount on 
          Line 6.
     •    If you have more than one employer, consider claiming zero allowances with the employer(s) where you earn 
          less income.

Signature
I certify that I am entitled to the number of withholding allowances claimed on this certificate.

Employee’s Signature                                       Date

                                                                                                                               Form W-4VT
                                                                                                                               Page 1 of 1
                         This form may be photocopied as needed.                                                                  Rev. 12/18