4 4 4 4 4 4 xemption tix00660069cate ys xemptions eases xcept Employees may x00660069le new certix00660069cate any number exemptions increasesx2022 Line to increase decrease tax for pay ID: 218576
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4 4 4 4 4 4 Purpose: Complete form L-4 so that your employer can withhold the correct amount of state income tax from your salary.Instructions: Employees who are subject to state withholding should complete the personal allowances worksheet indicating the number of withholding personal exemptions in Block A and the number of dependency credits in Block B.• Employees xemption ti�cate ys xemptions eases, xcept Employees may �le new certi�cate any number exemptions increases.• Line to increase decrease tax for pay period. Decreases indicated negative Penalties will be imposed for willfully supplying false information or willful failure to supply information that would reduce the withholding exemption. orm yer. yee xemption ti�cate, yer ax from the employee’s wages without exemption.Note to Employer: ti�cate ecords. ve yee operly xemptions edits, orward a copy of the employee’s signed L-4 form with an explanation as to why you believe that the employee improperly completed this form and any other supporting documentation. information to Department Revenue, Criminal Investigations Box Baton Rouge, 70821-2389. Block A• Enter ourself No exemptions or dependents claimed w. may enter you are married, have working more to avoid too little tax • Enter ourself, Single w. xemption xemption. xemption check number below.• Enter to yourself your spouse, check number below.Block B• Enter ourself eturn. enter Cut here and give the bottom portion of certi cate to your employer. Keep the top portion for your records. Form L-4Department of RevenueEmployee’s Withholding Allowance Certi cate 1. ype print �rst 2. Security 3. exemptions Married4. ess (number and street or rural route) CityState otal number of exemptions claimed in Block A otal number of dependents claimed in Block B Increase ative 8. eports xemptions ti�cate xceed number to Employee’s signatureDateThe following is to be completed by employer. Employer’s name and address10. Employer’s state withholding account number