A-4 Exception Withholding Certificate

Your Information

ALL QUESTIONS MUST BE ANSWERED BEFORE THE FORM WILL SUBMIT SUCCESSFULLY.

Name*

First Last

Email*

Social Security Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Information

ALL QUESTIONS MUST BE ANSWERED BEFORE THE FORM WILL SUBMIT SUCCESSFULLY.

Employer Name*

Pyro Shows of Alabama

Select the only choice available.

Employer FEIN*

81-1172593

Select the only choice available.

Employer State ID*

0816023422

Select the only choice available.

Withholding Exemptions

ALL QUESTIONS MUST BE ANSWERED BEFORE THE FORM WILL SUBMIT SUCCESSFULLY.

If you claim no personal exemption for yourself and wish to withhold at the highest rate, select "0". If not, select "N/A".*

0
N/A

If you are SINGLE or MARRIED FILING SEPARATELY, a $1,500 personal exemption is allowed. Select“S” if claiming the SINGLE exemption or “MS” if claiming the MARRIED FILING SEPARATELY exemption. If none of those apply, select "N/A".*

S
MS
N/A

If you are MARRIED or SINGLE CLAIMING HEAD OF FAMILY, a $3,000 personal exemption is allowed. Select “M” if you are claiming an exemption for both yourself and your spouse or “H” if you are single with qualifying dependents and are claiming the HEAD OF FAMILY exemption. Select "N/A" if none apply.*

M
H
N/A

Number of dependents (other than spouse) that you will provide more than one-half of the support for during the year.*

Please enter a number from 0 to 9.

Use "0" if this question does not apply to you.

Additional amount, if any, you want deducted each pay period

Please enter a number from 0 to 999.

Today's Date*

Signature*

Pyro Shows

A-4 Withholding Exception Certificate

Your Information

Employer Information

Withholding Exemptions

Tennessee

Alabama

Texas

South Carolina