State W-4

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Who is this from?*

Windstar Lines Safety System

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Employer's Name and Address*

Windstar Lines Inc, 1903 North US Hwy 71, Carroll, IA 51404, Phone 888-494-6378, Fax: 712-792-9615

Full Name*

First Middle Last

Which Branch location are you working out of?*

State W-4 Form

Instructions*

This form will auto calculate according to the answers that you provide. If you have a more complex employment arrangement, you may need to download a W4 and review the worksheets to complete this form.

If you need to make changes to your withholding, you may use this form to complete a new W-4 document as desired.

This form uses conditional logic to simplify the process. Based on the answers that you give, it will only show you the relevant options available. Once completed and submitted, it will populate the appropriate document for your home state. You may elect to receive a confirmation copy.

I understand the information provided.

Do you want a copy of this document for your records?

No, do not send me a copy for my records
I authorize and request the company to send me a copy of this document for my records

Iowa Department of Revenue

2020 IA W-4 Employee Withholding Allowance Certificate https://tax.iowa.gov 44-019a (11/01/19) Each employee must file this Iowa W-4 with his/her employer. Do not claim more allowances than necessary or you will not have enough tax withheld. You may file a new W-4 at any time if the number of your allowances increases. You must file a new W-4 within 10 days if the number of allowances previously claimed by you decreases. Penalties apply for willfully supplying false information or for willful failure to supply information, which would reduce the withholding allowances. If you file as exempt from withholding and you incur an income tax liability, you may be subject to a penalty for underpayment of estimated tax.

Missouri Department of Revenue

Notice to Employee: Return completed form to your Employer. Consider completing a new Form MO W-4 each year and when your personal or financial situation changes. Visit our online withholding calculator https://mytax.mo.gov/rptp/portal/home/withholding-calculator. Items to Remember: • Employees must complete a new form if their filing status changes or to adjust the amount of withholding. • If you are claiming an “Exempt” status due to the Military Spouses Residency Relief Act you must provide one of the following to your employer: Leave and Earnings Statement of the non-resident military servicemember, Form W-2 issued to the nonresident military servicemember, a military identification card, or specific military orders received by the servicemember. You must also provide verification of residency such as a copy of your state income tax return filed in your state of residence, a property tax receipt from the state of residence, a current drivers license, vehicle registration or voter ID card. For additional assistance in regard to Military, visit the department’s

Nebraska Department of Revenue

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

Illinois Department of Revenue

If you have more than one job or your spouse works, your withholding usually will be more accurate if you claim all of your allowances on the Form IL-W-4 for the highest-paying job and claim zero on all of your other IL-W‑4 forms. You may reduce the number of allowances or request that your employer withhold an additional amount from your pay, which may help avoid having too little tax withheld.

Step 1: Enter Personal Information

Your address:*

Street Address City State / Province / Region ZIP / Postal Code

Social Security Number*

Email*

Iowa Employee Withholding Certificate

Marital Status*

Single (or married but legally separated)
Married

If you do not expect to owe any income tax and have a right to a full refund of ALL income tax withheld, enter “EXEMPT” here and the year effective below. Nonresidents may not claim this exemption.*

Not Exempt
EXEMPT

Date*

Check this box if you are claiming an exemption from income tax as a military spouse based on the Military Spouses Residency Relief Act of 2009 or the Veterans Benefits and Transition Act of 2018

Not Exempt
Military EXEMPT

If claiming the military spouse exemption, enter your state of domicile or residence here*

State / Province / Region

Iowa Personal Allowances

If you are not exempt, complete the following:

Personal Allowances*

Yourself
You are single and have only one job; or
You are married, have only one job, and your spouse does not work; or
Your wages from a second job or your spouse’s wages (or the total of both for the year) are $1,500 or less

1a. Personal Allowances*

(a) 1 allowance for yourself or 2 allowances if you are unmarried and eligible to claim head of household status. Add 1 additional allowance if you are 65 or older, and/or 1 additional allowance if you are blind.

1b. Personal Allowances*

(b) If you are married and your spouse either does not work or is not claiming allowances on a separate W-4, you may claim the following allowances for them: 1 for your spouse, 1 additional allowance if your spouse is 65 or older, and/or 1 additional allowance if your spouse is blind.

1c. Personal Allowances*

(c) If you are single and hold more than one job, you may not claim the same allowances with more than one employer at the same time. If you are married and both you and your spouse are employed, you may not both claim the same allowances with both of your employers at the same time.

1e. Personal Allowances Calculation*

1. Personal Allowances*

See the calculation field above. This calculation is your calculated total. Enter your desired amount of allowances in this field. Remember that to have the highest amount of tax withheld claim "0" allowances on line 1.

2. Allowances for dependents.*

Allowances for dependents. You may claim 1 allowance for each dependent you claim on your Iowa income tax return.

Do you itemize deductions?*

No
Yes

3a. Enter total amount of estimated itemized deductions*

3b. Enter amount of your standard deduction*

Enter the amount of your standard deduction using the following information ......................If single, married filing separately on a combined return, or married filing separate returns, enter $2110. If married filing a joint return, unmarried head of household, or qualifying widow(er), enter $5210.

3c. Subtract line (b) from line (a) and enter the difference or zero, whichever is greater......*

3d. Additional allowance*

Additional allowance: Divide the amount on line (c) by $600, round to the nearest whole number and enter on line 3.

3. Allowances for itemized deductions.

4a Estimate alowable Adjustments

Allowances for adjustments to income. Estimate allowable adjustments to income for payments to an IRA, Keogh, or SEP; penalty on early withdrawal of savings; alimony paid; and student loan interest, which are reflected on the IA 1040.

4b. Calculation of Allowances for adjustments to income.*

Calculation Field = Allowances for adjustments to income.: Divide the amount on line (4a) by $600, round to the nearest whole number and enter on line 4.

4. Allowances for adjustments to income

Estimate allowable adjustments to income for payments to an IRA, Keogh, or SEP; penalty on early withdrawal of savings; alimony paid; and student loan interest, which are reflected on the IA 1040. You may enter the number on line 4b for standard calculation.

5. Allowances for Child and Dependent Care Credit

Persons having child/dependent care expenses qualifying for the federal and Iowa Child and Dependent Care Credit may claim additional Iowa withholding allowances based on their net incomes. If you have qualifying child and dependent care expenses and wish to reduce your Iowa withholding on the basis of this credit, you may claim additional withholding allowances for Iowa based on the information below. Taxpayers with net income of $45,000 or more cannot claim withholding allowances for the Child and Dependent Care Credit. Married persons, regardless of their expected Iowa filing status, must calculate their withholding allowances based on their combined net incomes. Total allowances for child and dependent care that you and your spouse may claim cannot exceed the total allowances shown below. Iowa net income between $0 - $19,999, enter an 5 allowances Iowa net income between $20,000 - $34,999, enter an 4 allowances Iowa net income between $35,000 - $44,999, enter an 3 allowances

6. Total Allowances

Add lines 1 through 5.

7. Additional amount, if any, you want deducted each pay period.Number

Missouri Employee's Withholding Certificate

This certificate is for income tax withholding and child support enforcement purposes only. Type or print.

1. Marital Status*

Note: If married, but legally separated, or spouse is a nonresident alien, check the “Single” box. Individuals filing income tax returns with a “Head of Household” status check the "Single" box.

Single or Married Spouse Works or Married Filing Separate
Married (Spouse does not work)
Head of Household

2. Additional withholding: If you expect to have a balance due (as a result of interest income, dividends, income from a part-time job, etc.) on your tax return, you may request your employer to withhold an additional amount of tax from each pay period. To calculate the amount needed, divide the amount of the expected tax by the number of pay periods in a year. Enter the additional amount to be withheld each pay period.*

3. Reduced withholding: If you expect to receive a refund (as a result of itemized deductions, modifications or tax credits) on your tax return, you may direct your employer to only withhold the amount indicated on line 3. Your employer will not use the standard calculations for withholding. If you designate an amount that is too low, it could result in you being under withheld. To calculate the amount needed, divide the amount of your expected tax by the number of pay periods in a year. Enter the amount to be withheld instead of the standard calculation. If no amount is indicated on line 3, the standard calculations will be used.*

Exempt Status: Select the appropriate reason you are claiming an exemption from withholding below and indicate EXEMPT.*

I am not exempt
I am exempt because I had a right to a refund of all Missouri income tax withheld last year and expect to have no tax liability this year. A new MO W-4 must be completed annually if you wish to continue the exemption.
I am exempt because I meet the conditions set forth under the Servicemember Civil Relief Act, as amended by the Military Spouses Residency Relief Act and have no Missouri tax liability.
I am exempt because my income is earned as a member of any active duty component of the Armed Forces of the United States and I am eligible for the military income deduction.

4. Exempt Status

Nebraska Employee's Withholding Allowance Certificate

Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject t o review by the Nebraska Department of Revenue (DOR). Your employer may be r equired to send a copy of this form to DOR.

Marital Status*

Note: If married, but legally separated, or spouse is a nonresident alien, check the “Single” box. Individuals filing income tax returns with a “Head of Household” status check the "Single" box.

Single
Married

Allowances Worksheet

4a. Enter “1” for yourself if no one else can claim you as a dependent.*

4b. Enter “1” if:*

You are single and have only one job; or •You are married, have only one job, and your spouse does not work; or •Your wages from a second job or your spouse’s wages (or the total of both for the year) are $1,500 or less

4c. Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one job. (Entering “-0-” may help you avoid having too little tax withheld.)*

But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one job. (Entering “-0-” may help you avoid having too little tax withheld.)

4d. Enter number of Nebraska personal exemptions (other than your spouse or yourself) you will claim on y our Nebraska tax return.*

This is the number of children and dependents you will list on your Nebraska return that qualify for either the child or dependent tax credit on the federal return.

4e. Enter “1” if you will file as head of household on your tax return.*

4f. Enter “1” if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit.*

4g. CALCULATION TOTAL*

Enter total of lines a though f here and on line 1 above. (Note: This may be different from the number of exemptions you claim on your Nebraska tax return)

1. Total number of allowances you are claiming*

The number from line 4g above.

2. Additional amount, if any, you want withheld from each paycheck for Nebraska income tax withheld.*

I claim exemption from withholding and I can provide satisfactory evidence to my employer that I meet both of the following conditions for exemption.*

I do not claim exemption
Last year I had a right to a refund of all Nebraska income tax withheld because I had no tax liability, and
This year I expect a refund of all Nebraska income tax withheld because I expect to have no tax liability.

If you can provide evidence that you can meet both conditions, select “Exempt” here.*

Not Exempt
Exempt

3. Exemption*

Employee’s and other Payee’s Illinois Withholding Allowance Certificate

Use this worksheet as a guide to figure your total withholding allowances you may enter on your Form IL-W-4.

Step 1

Step 1: Check all that apply:*

No one else can claim me as a dependent.
I can claim my spouse as a dependent.

1a. Enter the total number of boxes you checked.*

2a. Enter the number of dependents (other than you or your spouse) you will claim on your tax return.*

3a. Add Lines 1 and 2. Enter the result. This is the total number of basic personal allowances to which you are entitled. You are not required to claim these allowances. The number of basic personal allowances that you choose to claim will deter mine how much money is withheld from your pay.*

See Line 4 for more information.

4a. Enter the total number of basic personal allowances you choose to claim on this line and Line 1 of Form IL-W-4 below.*

This number may not exceed the amount on Line 3 above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay.

Step 2: Check all that apply:*

None Apply
I am 65 or older.
My spouse is 65 or older.
I am legally blind.
My spouse is legally blind.

Step 2

5a. Enter the total number of boxes you checked.*

6a. Enter any amount that you reported on Line 4 of the Deductions Worksheet for federal Form W-4 plus any additional Illinois subtractions or deductions.*

7a. Divide Line 6 by 1,000. Round to the nearest whole number.*

Enter the result on Line 7.

8a. Add Lines 5 and 7. Enter the result.*

This is the total number of additional allowances to which you are entitled. You are not required to claim these allowances. The number of additional allowances that you choose to claim will determine how much money is withheld from your pay.

9a. Enter the total number of additional allowances you elect to claim on Line 2 of Form IL-W-4, below.*

This number may not exceed the amount on Line 8 above, however, you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay.

IL-W-4 Employee’s Illinois Withholding Allowance Certificate

Check the box if you are exempt from federal and Illinois Income Tax withholding and sign and date the certificate.*

Not Exempt
Exempt

1. Enter the total number of basic allowances that you are claiming.*

Calculated (Step 1, Line 4, of the worksheet)

2. Enter the total number of additional allowances that you are claiming.*

Calculated (Step 2, Line 9, of the worksheet)

3. Enter the additional amount you want withheld (deducted) from each pay.*

Iowa Sign Here

I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this claim, and, to the best of my knowledge and belief, it is true, correct, and complete.

Missouri Sign Here

Under penalties of perjury, I certify that the information provided on this form is true and accurate.

Nebraska Sign Here

Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief, it is correct and complete.

Illinois Sign Here

I certify that I am entitled to the number of withholding allowances claimed on this certificate.

Arizona A-4

Please see the A-4 at the following link for further information: Arizona A-4 Form

Choose Box 1 or Box 2*

Box 1 - You will select withholding from 0.5% to 3.5%
Box 2 - I elect an Arizona withholding percentage of zero, and I certify that I expect to have no Arizona tax liability for the current taxable year.

Withhold from gross taxable wages at the percentage checked (check only one percentage):*

Would like an extra amount deducted from your check?*

Yes
No

Enter Amount*

Signature and Date

▲ Employee’s signature (This form is not valid unless you sign it.)

Date*

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Employers Only

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Company Name

MO W4 Employer Field

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Address

MO W4 Employer Field

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Missouri Tax ID

123-456987

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Nebraska ID Number

123-695874

State W-4 Form

Iowa Department of Revenue

Missouri Department of Revenue

Nebraska Department of Revenue

Illinois Department of Revenue

Step 1: Enter Personal Information

Iowa Employee Withholding Certificate

Iowa Personal Allowances

Missouri Employee's Withholding Certificate

Nebraska Employee's Withholding Allowance Certificate

Allowances Worksheet

Employee’s and other Payee’s Illinois Withholding Allowance Certificate

Step 1

Step 2

IL-W-4 Employee’s Illinois Withholding Allowance Certificate

Iowa Sign Here

Missouri Sign Here

Nebraska Sign Here

Illinois Sign Here

Arizona A-4

Signature and Date

Employers Only

You are not required to prepare a State W-4. Click submit and the mark as completed button and proceed to the next unit

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