Required Complete the W-4 for employment at Superore Wheels: Erma Jane Grant 441 West Hill Road Montrose, Colorado 81401 SSN: 432-55-6792 Single, head of household Two dependents She is eligible for the child tax credit because of her two allowances and an annual salary of $36,000. She is not claiming an additional amount to be withheld, nor is she claiming exemption from withholding. She has $1,500 annually in child care expenses (NOTE): The Instructions ordinarily found on the top of Form W-4 can be found on the second tab. Complete this question by entering your answers in the tabs below Form W4 Instructions Complete Form W4 Form W-4 (2017) Personal Allowances Worksheet (Keep for your records.) Form W-4 (2017) Personal Allowances Worksheet (Keep for your records.) A Enter '1" for yourself if no one else can claim you as a dependent You are single and have only one job; or . You are married, have only one job, and your spouse does not work; or .Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. B Enter "1h if C Enter" 1" for your spouse. But, you may choose to enter '0" if you are married and have either a working spouse or more than one job. Entering 0- may help you avoid having too little tax withheld.) D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return E Enter"1" if you wl file as head of household on your tax retum (see conditions under Head of household above) F Enter"1 if you have at least S2,000 of child or dependent care expenses for which you plan to claim a credit (Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses,for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. * If your total income will be less than $70,000 $ 100,000 if married enter "2 for each eligible child; then less "1" if you have two to four eligible children or less "2" if you have five or more elig ble children. If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter '1* for each eligble child H Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax retun.) * If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments worksheet on page 2. For accuracy, complete all worksheets that married), see the Two-Eamers/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld. apply. If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed S50,000 (S20,000 if If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below Separate here and give Form W-4 to your employer. Keep the top part for your records. Form W-4 Employee's Withholding Allowance Certificate OMB No. 1545-0074 Department of the Treasury - Internal Revenue Service Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by 2017 the IRS. Your employer may be required to send a copy of this form to the IRS 1 Your first name and middle initial Last name 2 Your social security number rant rma Home address (number and street or rural route) 441 West Hill Road City or town, state, and ZIP code Montrose, Colorado 81401 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 6 Additional amount, if any, you want withheld from each paycheck 7 Iclaim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption. 3 Single Note. If married, but legally separated, or spouse is a nonresident alien, check the 'single" box. 4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213 for a replacement card. Married Married, but withhold at higher Single rate. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and This year l expect a refund of all federal income tax withheld because l expect to have no tax iability If you meet both conditions, write "Exempt" here Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee's signature This form is not valid unless you sign it.) 8 Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) Date 9 Office code (optional 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 102200 Form W-4 (2017) THIS FORM IS A SIMULATION OF AN OFFICIAL U.S. TAX FORM. IT IS NOT THE OFFICIAL FORM ITSELF. DO NOT USE THIS FORM FOR