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State of Wisconsin  DEPARTMENT OF REVENUE EMPLOYEES – TAX CREDIT MAY PERMIT YOU TO CLAIM EXEMPTION FROM WISCONSIN WITHHOLDING TAX INCOME TAX CREDIT AVAILABLE Wisconsin law provides an income tax credit called the Working Families Tax Credit for certain lower-income individuals. The credit may be claimed on an individual’s 2012 Wisconsin income tax return. EXEMPTION FROM WITHHOLDING As a result of the Working Families Tax Credit, some employees will be permitted to claim exemption from having Wisconsin income tax withheld from the wages they receive during 2012. DO YOU QUALIFY? To determine if you can claim exemption from having Wisconsin income tax withheld from wages you receive during 2012 because of the Working Families Tax Credit, answer the following questions: . Will you be a legal resident of Wisconsin for the entire year 2012? 1 Yes. Go to question 2. No. Stop. You will not qualify for the Working Families Tax Credit for 2012. . Can you be claimed as a dependent on someone else’s 2012 Wisconsin income tax return (for example, by your parents)? 2 Yes. Stop. You will not qualify for the Working Families Tax Credit for 2012. No. Continue. Complete the worksheet below. . Worksheet. Must be completed to determine if you may claim exemption from Wisconsin withholding tax (keep this 3 worksheet for your records). . Fill in the total wages you expect to receive in 2012 (from all employers). 1 1. $ 2. If married, fill in the total wages you expect your spouse to receive in 2012 (from all employers). 2. . Fill in the total nonwage taxable income* you expect to receive during 2012. 3 3. 4. If married, fill in the total nonwage taxable income* you expect your spouse to receive during 2012. 4. . Total 2012 income. Add lines 1 through 4. 5 5. $ * Examples of nonwage taxable income include interest and dividend income, self-employment income, alimony, and unemployment compensation. 4 . (a). If you are unmarried, is line 5 of the Worksheet more than $10,000? Yes. Stop. You cannot claim exemption from withholding of Wisconsin income tax from your wages. No. Continue. You may claim exemption from withholding of Wisconsin income tax from your wages. To do so, complete the certificate which appears on the back of this page. Detach the completed certificate and give it to your employer. (b). If you are married, is line 5 of the Worksheet more than $19,000? Yes. Stop. You cannot claim exemption from withholding of Wisconsin income tax from your wages. No. Continue. You may claim exemption from withholding of Wisconsin income tax from your wages. To do so, complete the certificate which appears on the back of this page. Detach the completed certificate and give it to each of your employers. NEED ASSISTANCE? If you have questions about the Working Families Tax Credit, or need assistance in completing the worksheet on page 1, contact any Department of Revenue office. You may also call Madison at (608) 266-2776. If you prefer, you may write to: Wisconsin Department of Revenue PO Box 8949 Madison, WI 53708-8949 FAX 608-267-1030 Email: dorwithholdingtax@revenue.wi.gov CAUTION If you claim exemption from the withholding of Wisconsin income tax from your wages and subsequent changes in your income or marital status will result in your not being eligible for the Working Families Tax Credit, you must revoke the exemption. To revoke the exemption, you must notify your employer to resume withholding Wisconsin income tax from your wages. Use Wisconsin Form WT-4A to determine the amount your employer should withhold. Detach here and give completed certificate to your employer, if you qualify. WISCONSIN DEPARTMENT OF REVENUE Certificate of Exemption From Wisconsin Withholding for 2012 Based on the Working Families Tax Credit (Expires on December 31, 2012) FORM WT-4B Employee’s Full Name Social Security Number I CERTIFY that I will qualify for the Working Families Tax Credit for 2012 and claim exemption from withholding of Wisconsin income tax from the wages I receive during 2012. W-204B (R.11-11) Signature of employee Date Employee: Give the completed certificate to your employer to claim exemption from having Wisconsin income tax withheld from wages you receive during 2012. Employer: After receiving this certificate, discontinue withholding Wisconsin income tax from wages you pay to this employee during 2012. This certificate applies only to wages paid during 2012. Note: It is not necessary to provide a copy of this certificate to the Department of Revenue.