Georgia G4

Enter Personal Information
Last Name:
First Name:
Middle Initial:
Address:
City:
Social Security Number:
State:
Zip Code:
Single: Enter 0 or 1
Married Filing Joint, both spouses working: Enter 0 or 1
Married Filing Joint, one spouse working: Enter 0 or 1 or 2
Married Filing Separate: Enter 0 or 1
Head of Household: Enter 0 or 1
Enter the number of dependents (other than you or your spouse) you will claim on your tax return.
Enter the total number of Additional Allowances you choose to claim on this line. Complete the worksheet below to calculate.
Additional Withholding. Enter the additional amount you want withheld from your pay.
WORKSHEET FOR CALCULATING ADDITIONAL ALLOWANCES
(Must be completed in order to enter an amount on step 5)
I am 65 or older.
I am legally blind.
My spouse is 65 or older.
My spouse is legally blind.
Number of boxes checked x 1300
Federal Estimated Itemized Deductions.
Georgia Standard Deduction
(Single/Head of Household: $4,600 or Each Spouse $3,000):.
Subtract Line B from Line A (If zero or less, enter zero)
Allowable Deductions to Federal Adjusted Gross Income.
(Enter items such as Retirement Income Exclusion, U.S. Obligations, and other allowable deductions per Georgia Law.)
Add the Amounts on Lines 1, 2C, and 2D
Estimate of Taxable Income not Subject to Withholding.
Subtract Line F from Line E (if zero or less, stop here)
Divide the Amount on Line G by $3,000. Enter total here and on Line 5 above.
(This is the maximum number of additional allowances you can claim. If the remainder is over $1,500 round up)
I claim exemption from withholding because I incurred no Georgia income tax liability last year and I do not expect to have a Georgia income tax liability this year.
I certify that I am not subject to Georgia withholding because I meet the conditions set forth under the Servicemembers Civil Relief Act.
I certify that I am entitled to the number of withholding allowances claimed on this certificate.