Georgia Withholding Certificate (G-4)

Which Office are you Submitting Too

EMPLOYEE'S INFORMATION

Name(Required)

First Middle Last

Social Security Number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

MARITAL STATUS & ALLOWANCES

Please read the instructions provided on the second page of the G-4 PDF if you are unsure how to fill this part out.

Select your filing status(Required)

Depending on the selection you make, you will be asked an additional question regarding the number of allowances you would like to claim.

A. Single

B. Married Filing Jointly (both spouses work)

C. Married Filing Jointly (one spouse works)

D. Married Filing Separate

E. Head of Household

How many allowances would you like to claim?

Do you have any dependent allowances to claim?(Required)

Yes

Enter the number of dependent allowances below

Please enter a number from 0 to 10.

Generally, this is the same number that you use on your federal income tax return. Check to be sure that your qualifying dependents aren't included as dependents on another person's tax withholding forms or tax returns.

Enter any additional amount you would like withheld here

This is uncommon.

Enter the letter you selected for marital status(Required)

Enter the total number of allowances you are claiming(Required)

You will need to add the number of allowances you selected under marital status and the number of dependent allowances you are claiming (if any). If you typically include "additional allowances" on your G-4, you will need to fill out the paper version.

Please enter a number from 0 to 10.

EXEMPTION SECTION

Only check a box in this section if you are confident that you are exempt from withholding in the state of Georgia.

My state of residence is

State

My spouse's (servicemember) state of residence is

State

Date(Required)

Employee's Signature(Required)

I certify under penalty of perjury that I am entitled to the number of allowances or the exemption from withholding status claimed on this Form G-4. Also, I authorize my employer to deduct per pay period the additional amount listed above (if any).

Pyro Shows

G-4 (SOLO)

EMPLOYEE'S INFORMATION

MARITAL STATUS & ALLOWANCES

EXEMPTION SECTION

Tennessee

Alabama

Texas

South Carolina