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Last name
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2 Your Social Security number
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Home address (number and street or rural route)
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3
Single
Married
Married but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the Single" box.
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City or town, state and ZIP code
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4 If your last name differs from that shown on your social security card, check here. You must call 1-800-772-1213
for a replacement card. >
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| 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2. |
5 |
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| 6 Additional amount, if any, you want withheld from each paycheck |
6 |
$
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7 I claim exemption from withholding for 2008, and I certify that I meet both of the following conditions for exemption.
- Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and
- 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...............................................>
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| 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. |
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Date (month/day/year)
/
/
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| 8 Employer's name and address (Employer: Complete lines 8 and 10 only if sending to IRS.)
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Office code (optional)
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10 Employer Identification number (EIN)
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