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Get KY DoR 42A804 Form K-4 2013

Revenue Form K-4 42A804 11-13 KENTUCKY DEPARTMENT OF REVENUE EMPLOYEE S WITHHOLDING EXEMPTION CERTIFICATE Print Full Name Payroll No. Social Security No. Print Home Address HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS EMPLOYEE Failure to file this form with your employer will result in withholding tax deductions from your wages at the maximum rate. Keep this certificate with your records. 1. If SINGLE and you claim an exemption enter 1 if you do not.

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