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Get NC DoR NC-4 2009

Number Marital Status Head of Household Single First Name (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) M.I. Married or Qualifying Widow(er) Last Name County (Enter first five letters) Address City State Zip Code (5 Digit) Country (If not U.S.) (See Form NC-4 Instructions before completing this form) 1. Total number of allowances you are claiming (From Line F of the Personal Allowances Worksheet on Page 2) .00 , 2. Additional amount, if any, you want withheld from each pay peri.

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