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Printable Form W-4V Simi Valley California: What You Should Know

Page 2. If your Social Security number (SSN) is different from the individual identification number (I.D.) on your state-issued photo I.D. card or driver's license, enter the SSN from your card or a temporary I.D. to indicate the number on your temporary license or state-issued photo I.D. card. 2. Leave blank. 3. Select your payer's type of claim. Type of claim. If you are exempt (exempt because of a disability), enter your exemption number. If not, enter either 0 or your employer's name. Type of claim. If you are eligible for an employer-paid premium tax credit (PTC), enter the number on your payee statement of qualified health insurance premiums. If not, enter either 0 or your employer's name. Type of claim. Select one of the following types of claim; if you select more than one, choose the type most helpful to you. Averaged income Averaged monthly income Medicare Part B Self-employed Medicaid Employer or employee contributions Social Security Averaged or average monthly income if your claim or identification number is the same as your payer's. If you have other income from an alternate source, enter the details as appropriate. 4. Page 3. Page 3 of 4. Leave blank. Select if your income is taxed as personal or business income for California. 5. Page 5. Page 5 of 4. Type of claim. Select one of the following types; if you select more than one, choose the type most helpful to you. The following types of claim; if you selected more than one, select the type most helpful to you. Averaged or average monthly income Averaged income if your claim or identification number is the same as your payer's. 6. Page 6. Page 6 of 4. Type of claim. Select one of the following types; if you select more than one, choose the type most helpful to you. The following types of claim; if you selected more than one) Enter your employer's information You cannot enter a claim number if you are not the (payer) of the employee. A valid claim for tax withheld. Employer or employee contributions If you selected no, enter the number on the claim form. 7. Page 7. Page 7 of 4. Type of claim.

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