Form SW-4 Instructions - revised 1/05/10 
 
Purpose:  Complete form SW-4 so your employer can withhold the correct amount of city income taxes from your pay. 
 
Dependents:  To qualify as your dependent (line 4 below), a person  
  (a)  Must receive more than one-half of his or her support from you for the year, and 
  (b)  Must have less than $750.00 gross income during the year (except your child who is a student or who is under 19 years of 
       age, and 
  (c)  Must not be claimed as an exemption by such person’s husband or wife, and 
  (d)  Must be a citizen or resident of the United States, and 
  (e)  Must have your home as his/her principal residence and be a member of your household for the entire year, or Must be related 
       to you as follows:  Your son or daughter, grandchild, step-son/daughter, son/daughter-in-law, father, mother, grandparent, 
       step-father/mother, father/mother-in-law, brother, sister, stepbrother/sister, half brother/sister, brother/sister-in-law, uncle, aunt, 
       nephew, or niece (but only if related by blood). 
 
Changes in exemptions:  You must file a new certificate within 10 days if the number of exemptions previously claimed by you 
decreases for any of the following reasons: 
  (a)  Your wife/husband for whom you have been claiming exemption is divorced or legally separated, or claims her/his own 
       exemption on a separate certificate. 
  (b)  The support of a dependent for whom you claimed exemption is taken over by someone else. 
  (c)  You find that a dependent for whom you claimed exemption will receive $750.00 or more income of his/her own during the 
       year (except your child who is a student and who is under 19 years of age). 
Other Decreases: Such as the death of a wife, husband, or a dependent, do not affect your withholding until the next year, but require 
the filing of a new certificate by December 1 of the year in which they occur.  
 
Change of Residence:  You      must file a new certificate within 10 days after you change your residence from or to a taxing city. 
 
Employee: File this form with your employer.  Otherwise your employer must withhold City of Saginaw income tax from your earnings 
without exemptions. 
 
Employer: Keep this certificate with your record. If the information submitted by the employee is not believed to be true, correct and 
complete the City of Saginaw must be advised. 
 
 FORM SW-4                         EMPLOYEE’S WITHHOLDING CERTIFICATE FOR  
                                   CITY OF SAGINAW INCOME TAX 
       City Resident    or       Non-City Resident                             Your Social Security Number: 
                                                                                
 Full Name: (First, Middle and Last Name)                     Home Address:  (Number & Street) 
  
 City:                                                        State:                       Zip Code:
  
 Main place of employment:                                    City:                        Under                                                            
 Print name of each city where you work for this employer                                  25%                40%                                60%  80%  100%
 and circle closest % of total earnings in each. This is for 
 withholding purposes only.                                   City:                        Under                                                            
                                                                                           25%                40%                                60%  80%  100%
  
 1. Exemptions for yourself:                                 2. Exemptions for your spouse:                                                       3. Enter Total number of 
                                                                                                                                                  boxes checked in 1& 2: 
        Yourself         age 65 or over     Blind             Yourself                      age 65 or over      Blind                              
 4. Other Exemptions:                                                                      5.  Enter total number of Other Exemptions in 
                Number of exemptions                      Number of exemptions             box 4 below:  
                for your children                                for your other dependents 
 6. Add the number of exemptions which you have               7. Write the additional amounts you want withheld from each    
 claimed in box 3 & 5 and write the total below:              paycheck, if any: 

 Employer’s Name and Address: 
  
 I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief. 
  
 SIGNATURE:                                                                                                                               DATE: