Illinois W-4
Please fill out Form IL-W-4 to the best of your avaliability, if you are having problems filling out the form please stop by the office to fill out a physical form.
Office / Oficina
Please Select
Aurora
Crystal Lake
Diversey
Elgin
Freeport
Humboldt Park
Joliet
North Riverside
Oaklawn
Peru
Pilsen
Rockford
Rolling Meadows
South Holland
Sterling
Waukegan
Pulaski (DHS)
Would you like to fill out Step 1
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Yes
No
Check all that apply
No one else can claim me as a dependent
I can claim my spouse as a dependent
1. Enter the total number of boxes you checked
2. Enter the number of dependents (other than you or your spouse) you will claim on your tax return
3. 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 determine how much money is withheld from your pay. See Line 4 for more information.
4. 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
Would you like to fill out Step 2
*
Yes
No
Check all that apply
I am 65 or older
I am legally blind
My spouse is 65 or older
My spouse is legally blind
5. Enter the total number of boxes you checked
6. 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.
7. Divide Line 6 by 1,000. Round to the nearest whole number. Enter the result on Line 7
8. 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
9. 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.
Social Security Number (SSN)
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Name
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First Name
Middle Name
Last Name
Email
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Confirmation Email
Company (circle the one that applies) / Circula el departamento por cual trabaja
Homemakers
Seniorcare
Caregivers
Today's Date
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/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
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Street Address
Apt / Suite
City
State / Province
Postal / Zip Code
Check the box if you are exempt from federal and Illinois Income Tax withholding and sign and date the certificate
If applicable check box
1. Write the total number of basic allowances that you are claiming
2. Enter the total number of additional allowances that you are claiming (Step 2, Line 9, of the worksheet)
3. Enter the additional amount you want withheld (deducted) from each pay.
Your signature
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I certify that I am entitled to the number of withholding allowances claimed on this certificate.
Please verify that you are human
*
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