Name
Chapter 5
3
section:
problem solving
Activity 5.1 Form W-4, Employee’s Withholding Allowance Certificate
Directions: On the following Form W-4, supply the appropriate information for yourself. Assume that
you are beginning a new job and have been asked to complete the W-4 form for your employer.
Cut here and give Form W-4 to your employer. Keep the top part for your records.
Form
W-4
Department of the Treasury
Internal Revenue Service
1
Employee’s Withholding Allowance Cer tificate
OMB No. 1545-0074
20 – –
�
Whether you are entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
Type or print your first name and middle initial.
2
Last name
Your social security number
Home address (number and street or rural route)
3
City or town, state, and ZIP code
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. �
Single
Married
Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
5
5
Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)
6
7
6
Additional amount, if any, you want withheld from each paycheck
I claim exemption from withholding for 20--, and I certify that I meet both of the following conditions for exemption.
● Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and
● This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
�
If you meet both conditions, write “Exempt” here
7
$
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
(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.)
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
Date
9 Office code (optional) 10
Cat. No. 10220Q
�
Employer identification number (EIN)
Form
W-4
(20--)
Students should complete the form with their own information as if they were accepting a job, using the form in the textbook
as an example.
Section 3
Problem Solving
Activity 5.2 Form W-2, Wage and Tax Statement
Directions: On the following Form W-2, supply the information specified here: Employer’s name,
address, and ZIP Code—J.B. Dandy Co., 85 Front Street, Your City, State, ZIP; Employer’s identification
number—93-00400868; Employer’s State number—86114; Federal income tax withheld—$188.00;
Social Security tax withheld—$124.00; Medicare tax withheld—$29.00; wages, tips, and other
compensation—$2,000.00; and State income tax—$22.00. Use 999-00-1234 as the Social Security
number, and list your name, address, and ZIP. Do not record additional information on the form.
a Employee’s social security number
22222
OMB No. 1545-0008
b Employer identification number (EIN)
1
Wages, tips, other compensation
2
Federal income tax withheld
c Employer’s name, address, and ZIP code
3
Social security wages
4
Social security tax withheld
5
Medicare wages and tips
6
Medicare tax withheld
7
Social security tips
8
Allocated tips
9
Advance EIC payment
10
Nonqualified plans
12a See Instructions for box 12
d Control number
e Employee’s first name and initial
Last name
Suff.
11
13
Statutory
employee
14
Retirement
plan
Dependent care benefits
C
od
e
Third-party
sick pay
Other
12b
C
od
e
12c
C
od
e
12d
C
od
e
f Employee’s address and ZIP code
15 State
Form
Employer’s state ID number
W-2
Wage and Tax
Statement
16 State wages, tips, etc.
17 State income tax
20 – –
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Department of the Treasury—Internal Revenue Service
Students should fill in the Form W-2 with the information provided, using the form in the textbook as an example.
Chapter 5
Name