Use the following instructions to accurately complete your K-4 form, then detach the lower portion and give it to your employer. For assistance, call the Kansas Department of Revenue at 785-368-8222.

Purpose of the K-4 form: A completed withholding allowance certificate will let your employer know how much Kansas income tax should be withheld from your pay on income you earn from Kansas sources. Because your tax situation may change, you may want to refigure your withholding each year.

Exemption from Kansas withholding: To qualify for exempt status you must verify with the Kansas Department or Revenue that: 1 last year you had the right to a refund

employer. If your employer does not receive of all STATE income tax withheld because a K-4 form from you, they must withhold you had no tax liability; and 2 this year you Kansas income tax from your wages without will receive a full refund of all STATE income exemption at the “Single” allowance rate. tax withheld because you will have no tax liability. Head of household: Generally, you may claim head of household filing status on Basic Instructions: If you are not exempt, your tax return only if you are unmarried complete the Personal Allowance and pay more than 50% of the cost of Worksheet that follows. The total on line F keeping up a home for yourself and for should not exceed the total exemptions you your dependents. claim under “Exemptions and Dependents” on your Kansas income tax return. Nonwage income: If you have a large NOTE: Your status of “Single” or “Joint” may amount of nonwage Kansas source differ from your status claimed on your income, such as interest or dividends, federal Form W-4. consider making estimated tax payments on Form K-40ES. Without these payments, Using the information from your Personal you may owe additional Kansas tax when Allowance Worksheet, complete the K-4 you file your state income tax return. form below, sign it and provide it to your

Personal Allowance Worksheet (Keep for your records)

A Allowance Rate: If you are a single filer mark “Single

If you are married and your spouse has income mark “Single

If you are married and your spouse does not work mark “Joint

B Enter “0” or “1” if you are married or single and no one else can claim you as a dependent entering “0” may

help you avoid having too little tax withheld .

C Enter “0” or “1” if you are married and only have one job, and your spouse does not work entering “0” may help

you avoid having too little tax withheld

E Enter the number of dependents you will claim on your tax return. Do not claim yourself or your spouse or

dependents that your spouse has already claimed on their form K-4.

F Add lines B through E and enter the total here

Cut here and give the lower portion to your employer. Keep the top portion for your records.

Whether you are entitled to claim a certain number of allowances or exemptions from withholding is subject to review by the Kansas Department of Revenue. Your employer may be required to send a copy of this form to the Kansas Department of Revenue.

3 Allowance Rate

Note: The Kansas Department of Revenue will receive your federal W-2 forms for all years claimed Exempt.

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.

SIGN HERE

DATE