Form W-4 GREENWOOD SCHOOL DISTRICT 50 Department of the Treasury – Internal Revenue Service EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE * * PRINT YOUR NAME AS IT IS LISTED ON YOUR SOCIAL SECURITY CARD * *		For Payroll Office Use Only CHANGES Marital No. Status Exemptions Date
Last Name First Name Middle Initial Social Security Number
Address City State Zip Code
Marital Status (NOTE: If married, but legally separated, or spouse is a nonresident alien, check the Single box.) q Single q Married q Married, but withhold at higher Single rate
Total number of allowances you are claiming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional amount, if any, you want deducted from each paycheck . . . . . . . . . . . . . . . . . . I claim exemption from withholding and I certify that I meet ALL of the following conditions for exemption: Ÿ Last year I had a right to a refund of ALL Federal income tax withheld because I had NO tax liability; AND Ÿ This year I expect a refund of ALL Federal income tax withheld because I expect to have NO tax liability; If you meet both conditions, write “EXEMPT” here (A copy of this form will be sent to the IRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you are claiming different allowances for S.C. Tax Commission, enter the number of exemptions here (cannot be more than Federal exemptions) . . . . . . . . . . . . . . . . . . . . . .	Ÿ	_____________________ _____________________ Substitutes Only Answer Yes or No Are you a member of the S.C. Retirement System now? _______ High School Graduate? _______ Years of College Training _______ S.C. Certified? _______
	Ÿ
	Ÿ
	Ÿ
Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate, or if claiming exemption from withholding, that I am entitled to claim the exempt status. Employee’s Signature Date , 20		For Payroll Office Use Only Documentation ______________ Daily Rate of Pay ____________