“Help us to stay online by your kind donation.
Every penny will help.”
Withholding Tax Information
Taxation Identification Number:
Number of Dependents:
Number of Excemptions:
Spouse's Taxation Identification. Number:
Exemptions from Federal/State taxes:
[Attach Certificates of Exemption]
The number of dependents claimed is accurate and I shall notify the personnel department of any change in dependents.
Name of Employee
Change in Number of Dependents
Dependents [List All Dependents].
Have each dependent initial beside their name [If at all Possible].
*** If Required By State Law ***
This Section for Notary:
STATE OF -------)
) ss: [Date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]