Kentucky Withholding Certificate (K-4)

K-4 (SOLO)

YOUR INFORMATION

Name(Required)

First Last

Social Security Number

Address(Required)

Street Address City State ZIP Code

WITHHOLDING INFORMATION

All Kentucky wage earners are taxed at a flat 5% rate with a standard deduction allowance of $2,690. The Department of Revenue annually adjust the standard deduction in accordance with KRS 141.081(2)(a). If you need additional clarification, please reference the Form K-4.

Check if exempt:(Required)

1. Kentucky income tax liability is not expected this year

2. You qualify for the Fort Campbell Exemption Certificate

3. You qualify for the non-resident military spouse exemption

4. You work in Kentucky and reside in a reciprocal state

None of the exemptions apply

If yes, select the servicemember's state of domicile

State

I work in Kentucky and reside in:

Additional withholding per pay period under agreement with employer

Only add something here if you believe you require more than 5% to be withheld per pay check.

Employee's Signature(Required)

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.

Date(Required)

Pyro Shows

K-4 (SOLO)

YOUR INFORMATION

WITHHOLDING INFORMATION

Tennessee

Alabama

Texas

South Carolina