Instructions  for employee withholding certificate

Dependents - To qualify as your dependent (line                                                          Other Decreases   - in exemptions, such as the 
7a ) a person must qualify as your dependent as                                                          death of a spouse or dependent, do not affect 
provided in the Federal Internal Revenue Code.                                                           your withholdings until the next year but require 
                                                                                                         the filing of a new certificate by December 1 of the 
                                                                                                         year in which they occur. 
Changes in Exemptions - You should file a new 
certificate any time the number of your                                                                  Change of Residence - You must file a new 
exemptions increases. You must file a new                                                                certificate within 10 days after you change your 
certificate within 10 days if the number of                                                              residence from or to a taxing city.  
exemptions previously claimed by you 
DECREASES.                                                                                               Additional withheld -  You may designate 
                                                                                                         additional withholding if you expect to owe more 
                                                                                                         than the amount withheld. 

                                                                                                                                           Print Form            BC W-4
                                                           EMPLOYEES WITHOLDING CERTIFICATE 
                                                       FOR THE CITY OF BATTLE CREEK INCOME TAX 

1. Print full name                                         2. Social Security Number                           3. Battle Creek Resident? Yes                     No

4. Address                                                             City, Township or Village where you reside State                                          Zip Code

                                                                                                                                         MI
                               Check boxes that apply
Employee - File this form 
with your employer,            5. Exemptions for yourself: Regular     Age 65 & older                    Blind Deaf                        Enter number of 
                                                           Exemption   or Disabled                                                       exemptions checked
otherwise your employer 
must withhold Battle Creek     6. Exemptions for your      Regular     Age 65 & older                    Blind Deaf                        Enter number of 
income tax from your               spouse:                 Exemption   or Disabled                                                       exemptions checked
earnings without exemptions.   7a. Exemptions for your children Number 7b. Exemptions for your other dependents Number                     Enter total of line 
                                                                                                                                           7 (a plus b)
Employer - Keep this 
certificate with your records. 8.  Add the number of exemptions which you have claimed on lines 5, 6, 7 a & b above and write the total.   Total 
If the information submitted 
by the employee is not 
believed to be true, correct   8.  Additional amount you want deducted from each pay (if employer agrees)
and complete,and the Battle    I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
Creek Income Tax 
Department must be so          Date                        Signature
advised.