2009 Form W-4

Deductions and Adjustments Worksheet
Table 1
Table 2

Form W-4 (2009)

Purpose.

Complete Form W-4 so that your

employer can withhold the correct federal income

tax from your pay. Consider completing a new

Form W-4 each year and when your personal or

financial situation changes.

Head of household.

Generally, you may claim

head of household filing status on your tax

return only if you are unmarried and pay more

than 50% of the costs of keeping up a home

for yourself and your dependent(s) or other

qualifying individuals. See Pub. 501,

Exemptions, Standard Deduction, and Filing

Information, for information.

Exemption from withholding.

If you are

exempt, complete

only

lines 1, 2, 3, 4, and 7

and sign the form to validate it. Your exemption

for 2009 expires February 16, 2010. See

Pub. 505, Tax Withholding and Estimated Tax.

Check your withholding.

After your Form W-4

takes effect, use Pub. 919 to see how the

amount you are having withheld compares to

your projected total tax for 2009. See Pub.

919, especially if your earnings exceed

$130,000 (Single) or $180,000 (Married).

Basic instructions.

If you are not exempt,

complete the

Personal Allowances Worksheet

below. The worksheets on page 2 further adjust

your withholding allowances based on itemized

deductions, certain credits, adjustments to

income, or two-earner/multiple job situations.

Two earners or multiple jobs.

If you have a

working spouse or more than one job, figure

the total number of allowances you are entitled

to claim on all jobs using worksheets from only

one Form W-4. Your withholding usually will

be most accurate when all allowances are

claimed on the Form W-4 for the highest

paying job and zero allowances are claimed on

the others. See Pub. 919 for details.

Personal Allowances Worksheet

(Keep for your records.)

Enter “1” for

yourself

if no one else can claim you as a dependent

c You are single and have only one job; or

Enter “1” if:

c You are married, have only one job, and your spouse does not work; or

c Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less.

Enter “1” for

your

spouse.

But, you may choose to enter “-0-” if you are married and have either a working spouse

more than one job. (Entering “-0-” may help you avoid having too little tax withheld.)

Enter number of

dependents

(other than your spouse or yourself) you will claim on your tax return

Add lines A through G and enter total here. (

Note.

This may be different from the number of exemptions you claim on your tax return.)

c If you plan to

itemize or claim adjustments to income

and want to reduce your withholding, see the

Deductions

and Adjustments Worksheet

on page 2.

For accuracy,

complete all

worksheets

that apply.

c If you have

more than one job

or are

married and you and your spouse both work

and the combined earnings from all jobs exceed

$40,000 ($25,000 if married), see the

Two-Earners/Multiple Jobs Worksheet

on page 2 to avoid having too little tax withheld.

c If

neither

of the above situations applies,

stop here

and enter the number from line H on line 5 of Form W-4 below.

Cut here and give Form W-4 to your employer. Keep the top part for your records.

OMB No. 1545-0074

Employee's Withholding Allowance Certificate

W-4

Form

Department of the Treasury

Internal Revenue Service

Whether you are entitled to claim a certain number of allowances or exemption from withholding is

subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

Type or print your first name and middle initial.

Last name

Your social security number

Home address (number and street or rural route)

Married

Single

Married, but withhold at higher Single rate.

City or town, state, and ZIP code

Note.

If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

Total number of allowances you are claiming (from line

above

from the applicable worksheet on page 2)

Additional amount, if any, you want withheld from each paycheck

I claim exemption from withholding for 2009, and I certify that I meet

both

of the following conditions for exemption.

c Last year I had a right to a refund of

all

federal income tax withheld because I had

tax liability

and

c This year I expect a refund of

all

federal income tax withheld because I expect to have

tax liability.

If you meet both conditions, write “Exempt” here

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.

Employee's signature

(Form is not valid unless you sign it.)

Date

Employer identification number (EIN)

Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

Office code (optional)

Enter “1” if you have at least $1,800 of

child or dependent care expenses

for which you plan to claim a credit

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.

Cat. No. 10220Q

Enter “1” if you will file as

head of household

on your tax return (see conditions under

Head of household

above)

Note.

You cannot claim exemption from

withholding if (a) your income exceeds $950

and includes more than $300 of unearned

income (for example, interest and dividends)

and (b) another person can claim you as a

dependent on their tax return.

Nonwage income.

If you have a large amount

of nonwage income, such as interest or

Child Tax Credit

(including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

c If your total income will be between $61,000 and $84,000 ($90,000 and $119,000 if married), enter “1” for each eligible

child plus “1”

additional

if you have six or more eligible children.

c If your total income will be less than $61,000 ($90,000 if married), enter “2” for each eligible child; then

less

“1” if you have three or more eligible children.

(

Note.

not

include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

Tax credits.

You can take projected tax

credits into account in figuring your allowable

number of withholding allowances. Credits for

child or dependent care expenses and the

child tax credit may be claimed using the

Personal Allowances Worksheet

below. See

Pub. 919, How Do I Adjust My Tax

Withholding, for information on converting

your other credits into withholding allowances.

Nonresident alien.

If you are a nonresident

alien, see the Instructions for Form 8233

before completing this Form W-4.

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Form

W-4

(2009)

Complete all worksheets that apply. However, you

may claim fewer (or zero) allowances. For regular

wages, withholding must be based on allowances

you claimed and may not be a flat amount or

percentage of wages.

dividends, consider making estimated tax

payments using Form 1040-ES, Estimated Tax

for Individuals. Otherwise, you may owe

additional tax. If you have pension or annuity

income, see Pub. 919 to find out if you should

adjust your withholding on Form W-4 or W-4P.

Page

Form W-4 (2009)

Deductions and Adjustments Worksheet

Note.

Use this worksheet

only

if you plan to itemize deductions, claim certain credits, adjustments to income, or an additional standard deduction.

Enter an estimate of your 2009 itemized deductions. These include qualifying home mortgage interest,

charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and

miscellaneous deductions. (For 2009, you may have to reduce your itemized deductions if your income

is over $166,800 ($83,400 if married filing separately). See

Worksheet 2

in Pub. 919 for details.)

$11,400 if married filing jointly or qualifying widow(er)

$ 8,350 if head of household

Enter:

$ 5,700 if single or married filing separately

Subtract

line 2 from line 1. If zero or less, enter “-0-”

Enter an estimate of your 2009 adjustments to income and any additional standard deduction. (Pub. 919)

Add

lines 3 and 4 and enter the total. (Include any amount for credits from

Worksheet 8

in Pub. 919.)

Enter an estimate of your 2009 nonwage income (such as dividends or interest)

Subtract

line 6 from line 5. If zero or less, enter “-0-”

Divide

the amount on line 7 by $3,500 and enter the result here. Drop any fraction

Enter the number from the

Personal Allowances Worksheet,

line H, page 1

Add

lines 8 and 9 and enter the total here. If you plan to use the

Two-Earners/Multiple Jobs Worksheet,

also enter this total on line 1 below. Otherwise,

stop here

and enter this total on Form W-4, line 5, page 1

Two-Earners/Multiple Jobs Worksheet

(See

Two earners or multiple jobs

on page 1.)

Note.

Use this worksheet

only

if the instructions under line H on page 1 direct you here.

Enter the number from line H, page 1 (or from line 10 above if you used the

Deductions and Adjustments Worksheet)

Find the number in

Table 1

below that applies to the

LOWEST

paying job and enter it here.

However,

you are married filing jointly and wages from the highest paying job are $50,000 or less, do not enter more

than “3.”

If line 1 is

more than or equal to

line 2, subtract line 2 from line 1. Enter the result here (if zero, enter

“-0-”) and on Form W-4, line 5, page 1.

Do not

use the rest of this worksheet

Note.

If line 1 is

less than

line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4–9 below to calculate the additional

withholding amount necessary to avoid a year-end tax bill.

Enter the number from line 2 of this worksheet

Enter the number from line 1 of this worksheet

Subtract

line 5 from line 4

Find the amount in

Table 2

below that applies to the

HIGHEST

paying job and enter it here

Multiply

line 7 by line 6 and enter the result here. This is the additional annual withholding needed

Divide line 8 by the number of pay periods remaining in 2009. For example, divide by 26 if you are paid

every two weeks and you complete this form in December 2008. Enter the result here and on Form W-4,

line 6, page 1. This is the additional amount to be withheld from each paycheck

Privacy Act and Paperwork Reduction Act Notice.

We ask for the information on

this form to carry out the Internal Revenue laws of the United States. The Internal

Revenue Code requires this information under sections 3402(f)(2)(A) and 6109 and

their regulations. Failure to provide a properly completed form will result in your

being treated as a single person who claims no withholding allowances; providing

fraudulent information may also subject you to penalties. Routine uses of this

information include giving it to the Department of Justice for civil and criminal

litigation, to cities, states, the District of Columbia, and U.S. commonwealths and

possessions for use in administering their tax laws, and using it in the National

Directory of New Hires. We may also disclose this information to other countries

under a tax treaty, to federal and state agencies to enforce federal nontax criminal

laws, or to federal law enforcement and intelligence agencies to combat terrorism.

The average time and expenses required to complete and file this form will vary

depending on individual circumstances. For estimated averages, see the

instructions for your income tax return.

Table 1

All Others

Married Filing Jointly

If wages from

LOWEST

paying job are—

Table 2

All Others

Married Filing Jointly

If wages from

HIGHEST

paying job are—

Enter on

line 7 above

If wages from

HIGHEST

paying job are—

Enter on

line 7 above

Enter on

line 2 above

If wages from

LOWEST

paying job are—

You are not required to provide the information requested on a form that is

subject to the Paperwork Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its instructions must be

retained as long as their contents may become material in the administration of

any Internal Revenue law. Generally, tax returns and return information are

confidential, as required by Code section 6103.

Enter on

line 2 above

If you have suggestions for making this form simpler, we would be happy to hear

from you. See the instructions for your income tax return.

$0 -

4,501 -

9,001 -

18,001 -

22,001 -

26,001 -

32,001 -

38,001 -

46,001 -

55,001 -

60,001 -

65,001 -

75,001 -

95,001 -

105,001 -

$4,500

9,000

18,000

22,000

26,000

32,000

38,000

46,000

55,000

60,000

65,000

75,000

95,000

105,000

120,000

120,001 and over

$0 -

6,001 -

12,001 -

19,001 -

26,001 -

35,001 -

50,001 -

65,001 -

80,001 -

90,001 -

$6,000

12,000

19,000

26,000

35,000

50,000

65,000

80,000

90,000

120,000

120,001 and over

$0 -

65,001 -

120,001 -

185,001 -

$550

910

1,020

1,200

1,280

330,001 and over

$65,000

120,000

185,000

330,000

$0 -

35,001 -

90,001 -

165,001 -

$550

910

1,020

1,200

1,280

370,001 and over

$35,000

90,000

165,000

370,000