W-4 Submission

Tri-State Stage Labor Bringing the event to you....

Section One
First name and middle initial*
Last name*
Address*
Street Address Address Line 2 City State ZIP Code
Section Two
Social Security Number*
Section Three
Select one*
- Single
- Married
- Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
Section Four
Name differs from what is on your Social Security Card
- YES
If your name differs from what is on your Social Security Card then check here
Section Five
Total number of allowances you are claiming
Section Six
Additional amount, if any, you want withheld from each paycheck
Section Seven
If you meet both conditions, write “Exempt” here
I claim exemption from withholding for 2012, and I certify that I meet both of the following conditions for exemption. • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and • This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
Date*
Signature*

Section One