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HW-4                        EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF HAMTRAMCK INCOME TAX
F   t n i r P           . 1 N   l l u ame                                 So S   l a i c ec #   y t i r u                                              O c i f f a l P   , e   , t n De . t p                                 E           m o l p   ye d I   e e      c i f i t n    o i t a #   n

2.     Address, Number and Street                                         City, Township or Village                                                    State                 Zip Code                                             Are you a Hamtramck resident?
                                                                                                                                                                                                                                          Yes                                                     No
e r P           . 3 dom n i a a l P   t n c e   f o   e m o l p yme : t n    y t i C                                                                     und        r e
                                                                                                                                                         25%                         40%                   60%                          80%                    100%
Print name of each city where you work for THIS                           City                                                                                                                                                                                                                    Total
employer and circle closest % of total earnings in                                                                                                       under                                                                                                                                    number of 
each.                                                                                                                                                    25%                         40%                   60%                          80%                    100%                               boxes
YOU   R W T I         HHOL             N I D G                            4 Exem o i t p       ns                      Reg $   r a l u 600                                   Ad o i t i d   n $   l a   60   0                                       Ad     o i t i d n    l a
EXEMPTIONS:                                                     Check     for                                          personal                                              exemption if 65 or                                                      $600 exemption
                                                                which     yourself.                                    exemption                                             over by end of tax year                                                 if blind
(See instructions below.)                                       blocks    5 Exemptions                                 Regular $600                                          Additional $600                                                         Additional
                                                                apply     for your                                     personal                                              exemption if 65 or                                                      $600 exemption
                                                                          spouse.                                      exemption                                             over by end of tax year                                                 if blind
                                                                                                                         Numb r e                                                                                             Numb r e
EMPLOYEE: File this form with your employer.                               6. (a) Exemptions for                                                        6. (b) Exemptions for your                                                                   Enter total of 
Otherwise he must withhold CITY OF                                                     your children                                                             other dependents.                                                                   line 6(a) + 6(b)
HAMTRAMCK Income Tax from your earnings 
without  exemptions.                                                        A   . 7  d h t   d n   e umb e   f o   r e xem o i t p n   s w c i h y   h o h   u av      i a l c   e me o   d   n i l   n e a   , 5   , 4   s n a   6   d bov a   , e n e   d h   r e t n       . e r e

                                                                          8. Additional amount, if any, you want withheld from each paycheck.                                                                                                        $
EMPLOYER: Keep this certificate with your.
records.  If the information submitted by the                             I certify that the information submitted on this certificate is true, correct and complete to the best of my 
employee is not believed to be true, correct                              knowledge and belief.
and complete, the DIRECTOR OF FINANCE
mu b   t s s   e      a   o d s i v   e . d                               D : e t a                                                              g i S n : e r u t a

LINE 3 INSTRUCTIONS:
                            If you work for this employer in more than two cities or communities, print names of the two Michigan cities or communities where
                            you perform the greatest percent of your work.  Circle the closest percent of total earnings for work done, or services rendered in 
                            each city or community listed.  The estimated percent of total earnings from this employer for work done or services performed 
                            within taxing cities, is for withholding purposes only.  In determining final tax liability, this estimate is subject to substantiation and 
                            audit.
DEPENDENTS:
                            To qualify as your dependent, 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 or a resident of Canada, Mexico, the Republic of Panama or the Canal Zone (this does not apply to an alien child legally
                            adopted by and living with a United States citizen abroad), and (e) must (1) have your home as his principal residence and be a
                            member of your household for the entire year, or (2) be related to you as follows:
                                             Your son or daughter (including legally adopted children), grandchild, stepson, stepdaughter, son-in-law, or daughter-in-law;
                                             Your father, mother, grandparent, stepfather, stepmother, father-in-law, or mother-in-law;
                                             Your brother, sister, stepbrother, stepsister, half brother, half sister, brother-in-law or sister-in-law;
                                             Your uncle, aunt, nephew, or niece (but only if related by blood).
CHANGES IN EXEMPTIONS:
                            You should file a new certificate at any time if the number of your exemptions INCREASES.  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:
                                             Your spouse for whom you have been claiming exemption is divorced or legally separated, or claims their own exemption 
                                             on a separate certificate.
                                             The support of a dependent for whom you claimed exemption is taken over by someone else, so that you no longer 
                                             expect to furnish more than half the support for the year.
                                             Youfind that a dependent for whom you claimed exemption will receive $600 or more of income of his own during the 
                                             year (except your child who is a student or who is under 19 years of age).
                            Other decreases in exemptions, such as the death of a wife 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.
CHANGES IN EMPLOYMENT:
                            You must file a new certificate by December 1 of each year if your line 3 estimate of the percent of work done for services to be 
                            rendered in cities levying an income tax will change for the next year.






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