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, .00 <br /> <br /> <br /> <br /> <br />Web <br />11-22 <br />NC-4 Employee’s Withholding Allowance Certificate <br /> <br /> PURPOSE - Complete Form NC-4 so that your employer can withhold the <br />correct amount of State income tax from your pay. If you do not submit Form NC-4 to your employer, your employer must withhold as if your filing status is “Single” with no withholding allowances. <br />FORM NC-4EZ - You may use Form NC-4EZ if you plan to claim either the <br />N.C. Standard Deduction or the N.C. Child Deduction Amount (but no other <br />N.C. deductions), and you do not plan to claim any N.C. tax credits. <br />FORM NC-4 NRA - If you are a nonresident alien, you must use Form NC-4 <br />NRA. In general, a nonresident alien is an alien (not a U.S. citizen) who has not <br />passed the green card test or the substantial presence test. (See Publication 519, U.S. Tax Guide for Aliens, for more information on the green card test and the substantial presence test.) <br />FORM NC-4 BASIC INSTRUCTIONS - Complete the NC-4 Allowance Worksheet. The worksheet will help you determine your withholding <br />allowances based on federal and State adjustments to gross income <br />including the N.C. Child Deduction Amount, N.C. itemized deductions, <br />and N.C. tax credits. However, you may claim fewer allowances than <br />you are entitled to if you wish to increase the tax withheld during the tax <br />year. If your withholding allowances decrease, you must file a new NC-4 <br />with your employer within 10 days after the change occurs. Exception: <br />When an individual ceases to be “Head of Household” after maintaining <br />the household for the major portion of the year, a new NC-4 is not required <br />until the next year. <br />TWO OR MORE JOBS - If you have more than one job, determine the total <br />number of allowances you are entitled to claim on all jobs using one Form <br />NC-4 Allowance Worksheet. Your withholding will usually be most accurate <br />when all allowances are claimed on the NC-4 filed for the higher paying job <br />and zero allowances are claimed for the other. You should also refer to the <br />“Multiple Jobs Table” to determine the additional amount to be withheld on <br />Line 2 of Form NC-4 (See page 4). <br />NONWAGE INCOME - If you have a large amount of nonwage income, <br />such as interest or dividends, you should consider making estimated income <br /> <br />tax payments using Form NC-40 to avoid interest on the underpayment <br />of estimated income tax. Form NC-40 is available on the Department’s <br />website at www.ncdor.gov. <br /> HEAD OF HOUSEHOLD - Generally, you may claim “Head of Household” <br />filing status on your tax return only if you are unmarried and pay more than <br />50% of the costs of keeping up a home for yourself and your dependent(s) <br />or other qualifying individuals. <br /> SURVIVING SPOUSE - Generally, you may claim “Surviving Spouse” filing <br />status only if your spouse died in either of the two preceding tax years and <br />you meet the following requirements: <br /> <br />1. Your home is maintained as the main household of a child or stepchild <br />whom you can claim as a dependent; and <br />2. You were entitled to file a joint return with your spouse in the year of <br />your spouse’s death. <br /> MARRIED TAXPAYERS - For married taxpayers, both spouses must agree <br />as to whether they will complete the NC-4 Allowance Worksheet based on <br />the filing status, “Married Filing Jointly” or “Married Filing Separately.” <br /> <br />• Married taxpayers who complete the worksheet based on the filing <br />status, “Married Filing Jointly” should consider the sum of both <br />spouses’ income, federal and State adjustments to income, and State <br />tax credits to determine the number of allowances. <br /> <br />• Married taxpayers who complete the worksheet based on the filing <br />status, “Married Filing Separately” should consider only his or her <br />portion of income, federal and State adjustments to income, and State <br />tax credits to determine the number of allowances. <br /> All NC-4 forms are subject to review by the North Carolina Department of Revenue. Your employer may be required to send this form to the North Carolina Department of Revenue. <br /> <br /> <br /> <br /> <br /> <br />Web <br />10-17 <br />Cut here and give this certificate to your employer. Keep the top portion for your records.  <br />NC-4 Employee’s Withholding Allowance Certificate <br />1. Total number of allowances you are claiming <br />(Enter zero (0), or the number of allowances from Page 2, Line 17 of the NC-4 Allowance Worksheet) <br />2. Additional amount, if any, withheld from each pay period (Enter whole dollars) <br /> <br /> <br />Employee’s Signature Date <br /> <br />I certify, under penalties provided by law, that I am entitled to the number of withholding allowances claimed on Line 1 above. <br />CAUTION: If you furnish an employer with an Employee’s Withholding Allowance Certificate that contains information which has no <br />reasonable basis and results in a lesser amount of tax being withheld than would have been withheld had you furnished reasonable <br />information, you are subject to a penalty of 50% of the amount not properly withheld. <br />Single or Married Filing Separately Head of Household Married Filing Jointly or Surviving Spouse <br />Social Security Number Filing Status <br /> <br /> <br />First Name (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) M.I. Last Name <br />Address County (Enter first five letters) <br />City State Zip Code (5 Digit) Country (If not U.S.) <br />Docusign Envelope ID: 177AA06A-30B4-42FF-A85A-78B5A7C51DBE