Illinois W4

Enter Personal Information

Last Name:

First Name:

Middle Initial:

Address:

City:

Social Security Number:

State:

Zip Code:

No one else can claim me as a dependent.

I can claim my spouse as a dependent.

Enter the number of dependents (other than you or your spouse) you will claim on your tax return.

Here are the maximum personal allowances that you may choose to claim:

Enter the total number of basic personal allowances you choose to claim on this line. This number may not exceed the number in the box above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay.

I am 65 or older.
I am legally blind.
My spouse is 65 or older.
My spouse is legally blind.

Enter any amount that you reported on Line 4 of the Deductions Worksheet for federal Form W-4 plus any additional Illinois subtractions or deductions.

Total from the box above, divided by 1000, then rounded to the nearest whole number.

Here are the maximum additional allowances to which you are entitled. You are not required to claim these allowances. The number of additional allowances that you choose to claim will determine how much money is withheld from your pay.

Enter the total number of additional allowances you elect to claim on Line 2 of Form IL-W-4, below. This number may not exceed the amount on Line 8 above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay:

Enter any additional amount you want withheld(deducted) from each pay:

Check the box if you are exempt from federal and Illinois Income Tax withholding and sign and date the certificate.:

• Signature
• Clear