Virginia Form VA-4 (Employee's Withholding Exemption Certificate) (2024)

Employee's Withholding Exemption Certificate
VA-4 08 23 11.indd
FORM VA-4COMMONWEALTH OF VIRGINIADEPARTMENT OF TAXATIONPERSONAL EXEMPTION WORKSHEET(See back for instructions)1.If you wish to claim yourself, write “1”............................................................... ________________2.If you are married and your spouse is not claimed on his or her own certificate, write “1”................................................................ ________________3.Write the number of dependents you will be allowed to claimon your income tax return (do not include your spouse).................................... ________________4.Subtotal Personal Exemptions (add lines 1 through 3)...................................... ________________5.Exemptions for age (a)_If you will be 65 or older on January 1, write “1”................................... ________________ (b)_If you claimed an exemption on line 2 and your spouse_will be 65 or older on January 1, write “1”............................................. ________________6.Exemptions for blindness (a)_If you are legally blind, write “1”............................................................ ________________ (b)_If you claimed an exemption on line 2 and your_spouse is legally blind, write “1”............................................................ ________________7.Subtotal exemptions for age and blindness (add lines 5 through 6)...................................................._______________8.Total of Exemptions - add line 4 and line 7.........................................................................................._______________Detach here and give the certificate to your employer. Keep the top portion for your recordsFORM VA-4 EMPLOYEE’S VIRGINIA INCOME TAX WITHHOLDING EXEMPTION CERTIFICATEYour Social Security NumberNameStreet AddressCityStateZip CodeCOMPLETE THE APPLICABLE LINES BELOW1.If subject to withholding, enter the number of exemptions claimed on:(a)Subtotal of Personal Exemptions - line 4 of thePersonal Exemption Worksheet............................................................................................(b)Subtotal of Exemptions for Age and Blindnessline 7 of the Personal Exemption Worksheet........................................................................ (c)Total Exemptions - line 8 of the Personal Exemption Worksheet.........................................2.Enter the amount of additional withholding requested (see instructions)............................................2601064 Rev. 08/113.I certify that I am not subject to Virginia withholding. l meet the conditionsset forth in the instructions .................................................................................. (check here)4.I certify that I am not subject to Virginia withholding. l meet the conditions set forthUnder the Service member Civil Relief Act, as amended by the Military SpousesResidency Relief Act ........................................................................................... (check here)SignatureDateEMPLOYER: Keep exemption certificates with your records. If you believe the employee has claimed too many exemptions, notify the Department ofTaxation, P.O. Box 1115, Richmond, Virginia 23218-1115, telephone (804) 367-8037. Note: Employers may establish a system to electronically receiveForms VA-4 from employees, provided the system meets Internal Revenue Service requirements as specified in § 31.3402(f)(5)-1(c) of the TreasuryRegulations (26 CFR).FORM VA-4 INSTRUCTIONSUse this form to notify your employer whether you are subject to Virginia income tax withholding and how manyexemptions you are allowed to claim. You must file this form with your employer when your employment begins. If youdo not file this form, your employer must withhold Virginia income tax as if you had no exemptions.PERSONAL EXEMPTION WORKSHEETYou may not claim more personal exemptions on form VA-4 than you are allowed to claim on your incometax return unless you have received written permission to do so from the Department of Taxation.Line 1. You may claim an exemption for yourself.Line 2. You may claim an exemption for your spouse if he or she is not already claimed on his or her own certificate.Line 3. Enter the number of dependents you are allowed to claim on your income tax return.NOTE: A spouse is not a dependent.Line 5. If you will be age 65 or over by January 1, you may claim one exemption on Line 5(a). If you claim an exemption for your spouse on Line 2, and your spouse will also be age 65 or over by January 1, you may claim an additional exemption on Line 5(b).Line 6. If you are legally blind, you may claim an exemption on Line 6(a). If you claimed an exemption for your spouse on Line 2, and your spouse is legally blind, you may claim an exemption on Line 6(b).FORM VA-4Be sure to enter your social security number, name and address in the spaces provided.Line 1. If you are subject to withholding, enter the number of exemptions from:(a) Subtotal of Personal Exemptions - line 4 of the Personal Exemption Worksheet(b) Subtotal of Exemptions for Age and Blindness - line 7 of the Personal Exemption Worksheet(c) Total Exemptions - line 8 of the Personal Exemption WorksheetLine 2. If you wish to have additional tax withheld, and your employer has agreed to do so, enter the amount of additional tax on this line.Line 3. If you are not subject to Virginia withholding, check the box on this line. You are not subject to withholding if you meet any one of the conditions listed below. Form VA-4 must be filed with your employer for each calendar year for which you claim exemption from Virginia withholding.(a) You had no liability for Virginia income tax last year and you do not expect to have any liability for this year.(b) You expect your Virginia adjusted gross income to be less than the amount shown below for your filing status:Taxable Years Taxable Years Taxable Years Taxable Years2005, 20062008 and2010 and2012 andand 200720092011BeyondSingle$7,000$11,250$11,650$11,950Married$14,000$22,500$23,300$23,900Married, filing a separatereturn$7,000$11,250$11,650$11,950(c) You live in Kentucky or the District of Columbia and commute on a daily basis to your place of employment in Virginia.(d) You are a domiciliary or legal resident of Maryland, Pennsylvania or West Virginia whose only Virginia source income is from salaries and wages and such salaries and wages are subject to income taxation by your state of domicile.Line 4. Under the Servicemember Civil Relief Act, as amended by the Military Spouses Residency Relief Act, you maybe exempt from Virginia income tax on your wages if (i) your spouse is a member of the armed forces presentin Virginia in compliance with military orders; (ii) you are present in Virginia solely to be with your spouse; and(iii) you maintain your domicile in another state. If you claim exemption under the SCRA check the box on Line4 and attach a copy of your spousal military identification card to Form VA-4.

Extracted from PDF file 2023-virginia-form-va-4.pdf, last modified August 2011

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About the Individual Income Tax

2023 Form VA-4

VA-4 08 23 11.indd

2022 Form VA-4

VA-4 08 23 11.indd

2021 Form VA-4

VA-4 08 23 11.indd

2020 Form VA-4

VA-4 08 23 11.indd

2019 Form VA-4

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2018 Form VA-4

VA-4 08 23 11.indd

2017 Form VA-4

VA-4 08 23 11.indd

2016 Form VA-4

VA-4 08 23 11.indd

2015 Form VA-4

VA-4 08 23 11.indd

2013 Form VA-4

VA-4 08 23 11.indd

2012 Form VA-4

VA-4 08 23 11.indd

2011 Form VA-4

VA-4 08 23 11.indd