Outline
The Indiana WH-4 form, officially known as the Employee’s Withholding Exemption and County Status Certificate, plays a crucial role in determining how much state and county income tax is withheld from an employee's paycheck. This form is essential for both resident and nonresident employees who earn income subject to Indiana taxation. When completing the WH-4, individuals must provide their full name, Social Security number or ITIN, and home address, along with the Indiana county of residence and the county of principal employment as of January 1. The form allows employees to claim exemptions based on personal circumstances, including marital status, dependents, and age-related factors. For instance, individuals can claim one exemption for themselves, an additional one for a spouse if they do not claim it, and further exemptions for dependents. Additional considerations are made for those who are 65 years or older or legally blind, allowing for even more exemptions. Employees have the option to specify any extra amounts they wish to have withheld from their paychecks, providing flexibility in tax management. It is important to note that the completed WH-4 should be returned to the employer and not submitted to the Department of Revenue. Understanding the intricacies of this form is vital for employees to ensure proper tax withholding and compliance with state regulations.
Form Sample
Form
State Form 48845 (R10 /
State of Indiana
Employee’s Withholding Exemption and County Status Certificate
This form is for the employer’s records. Do not send this form to the Department of Revenue.
The completed form should be returned to your employer.
Full Name_ _______________________________________________________ Social Security Number or ITIN___________________________
Home Address_________________________________ City_______________________ State_______ |
ZIP Code_______________________ |
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Indiana County of Residence as of January 1:_________________________________________ |
(See instructions) |
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Indiana County of Principal Employment as of January 1:________________________________ |
(See instructions) |
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Check this box if the changes to the counties are effective for the next calendar year. (See instructions) □ |
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_____________________________________________________________________________________________________________________________________ |
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How to Claim Your Withholding Exemptions |
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1. |
You are entitled to one exemption. If you wish to claim the exemption, enter “1” |
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Nonresident aliens must skip lines 2 through 8. See instructions |
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2. |
If you are married and your spouse does not claim his/her exemption, you may claim it, enter “1” |
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3. |
You are allowed one (1) exemption for each dependent. Enter number claimed |
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4. |
Additional exemptions are allowed if: (a) you and/or your spouse are over the age of 65 and/or |
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(b) if you and/or your spouse are legally blind. |
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Check box(es) for additional exemptions: You are 65 or older □ or blind □ Spouse is 65 or older □ or blind □ |
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Enter the total number of boxes checked |
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5. |
Add lines 1, 2, 3, and 4. Enter the total here |
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6. |
You are entitled to claim an additional exemption for each qualifying dependent (see instructions) |
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7. |
You are entitled to claim an additional exemption for each qualifying dependent claimed for the first time (see instructions) |
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8. |
.................................You are entitled to claim an additional exemption for each adopted qualifying dependent (see instructions) |
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9. |
Enter the amount of additional state withholding (if any) you want withheld each pay period |
$__________ |
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10. |
Enter the amount of additional county withholding (if any) you want withheld each pay period |
$__________ |
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I hereby declare that to the best of my knowledge the above statements are true. |
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Signature:_ ______________________________________________________________________ |
Date:___________________________ |
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Instructions for Completing Form
This form should be completed by all resident and nonresident employees having income subject to Indiana state and/or county income tax.
Print or type your full name, Social Security number or ITIN and home address. Enter your Indiana county of residence and county of principal employment as of January 1 of the current year. If you neither lived nor worked in Indiana on January 1 of the current year, enter ‘not applicable’ on the line(s). If you move to (or work in) another county after January 1, your county status will not change until the next calendar year. Please check the box if you are requesting a change to a county of residence or work for the next calendar year.
Nonresident alien limitation. A nonresident alien is allowed to claim only one exemption for withholding tax purposes. If you are a nonresident alien, enter “1” on line 1, then skip to line 9. You are considered to be a nonresident alien if you are not a citizen of the United States and do not meet the green card test and the substantial presence test (get Publication 519 from www.irs.gov for information about these tests).
All other employees should complete lines 1 through 8.
Lines 1 & 2 - You are allowed to claim one exemption for yourself and one for your spouse (if he/she does not claim the exemption for him/herself). If a parent or legal guardian claims you on their federal tax return, you may still claim an exemption for yourself for Indiana purposes. You cannot claim more than the correct number of exemptions; however, you are permitted to claim a lesser number of exemptions if you wish additional withholding to be deducted.
Line 3 - Dependent Exemptions: You are allowed one exemption for each of your dependents based on state guidelines. To qualify as your dependent, a person must receive more than
Line 4 - Additional Exemptions. You are also allowed one exemption each for you and/or your spouse if either is 65 or older and/or blind. Line 5 - Add the total of exemptions claimed on lines 1, 2, 3, and 4. Enter the total in the box provided.
Line 6 - Additional Dependent Exemptions. An additional exemption is allowed for certain dependent children that are included on line 3. The dependent child must be a son, stepson, daughter, stepdaughter, foster child, and/or child for whom you are a legal guardian. The dependent must be under age 19 or must be both under age 24 and a
Line 7 -
Line 8 - Additional Adopted Dependent Exemptions. An additional exemption is allowed for certain dependent children that are included on lines 3 and 6 and have been adopted by you or your spouse. The dependent child must be a son, stepson, daughter, or stepdaughter. The dependent must be under age 19 or must be both under age 24 and a full- time student at a qualified educational institution during at least 5 months of the taxable year.
Lines 9 & 10 - If you would like an additional amount to be withheld from your wages each pay period, enter the amount on the line provided. NOTE: An entry on this line does not obligate your employer to withhold the amount. You are still liable for any additional taxes due at the end of the tax year. If the employer does withhold the additional amount, it should be submitted along with the regular state and county tax withholding.
You may file a new Form
(a)you divorce (or are legally separated from) your spouse for whom you have been claiming an exemption or your spouse claims him/herself on a separate Form
(b)someone else takes over the support of a dependent you claim or you no longer provide more than
(c)a dependent no longer qualifies for an additional dependent or an adopted dependent exemption.
Penalties are imposed for willingly supplying false information or information which would reduce the withholding exemption.
Form Specifics
| Fact Name | Description |
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| Form Purpose | The Indiana WH-4 form is used for employee withholding exemption and county status certification. |
| Governing Law | This form is governed by Indiana state tax laws regarding income withholding. |
| Submission Requirement | Employees must return the completed form to their employer, not the Department of Revenue. |
| Exemption Claim | Employees are entitled to claim one exemption for themselves and additional exemptions for dependents. |
| Nonresident Alien Rule | Nonresident aliens may only claim one exemption and must skip certain lines on the form. |
| Age and Blindness Exemptions | Additional exemptions are available for employees or spouses who are over 65 or legally blind. |
| Dependent Definition | To qualify as a dependent, a person must receive over half their support from the employee and meet income criteria. |
| Withholding Adjustments | Employees can specify additional amounts for state and county withholding on the form. |
| Form Update Requirement | A new WH-4 must be filed within 10 days if the number of exemptions decreases due to life changes. |
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