Form FW-4 Instructions 

Purpose:  Complete form FW-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 $600 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 $600 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 Flint 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 Flint must be advised. 

FORM FW-4                            EMPLOYEE’S WITHHOLDING CERTIFICATE 
                                     FOR  CITY OF FLINT INCOME TAX 

                                                              Your Social Security Number: 
        City Resident    or          Non-City Resident 

Full Name: (First, Middle and Last Name)               Home Address:  (Number & Street) 

City:                                                  State:              Zip Code:

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
          Number of exemptions                   Number of exemptions      in 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: