W-4 Form

W-4 Form–Employee’s Withholding Allowance Certificate

See Reverse Side Instructions

Please Print. This is a tax form. Do not use this form for an Address Change only (please see the Change of Address form available at

http://www.uwlax.edu/hr/ forms/address.change.pdf .) On each W-4 you submit you must indicate your marital and exemption status or it

will be assigned to Single with zero exemptions.



U.S. Social Security Number

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bookmark self-reference. –

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bookmark self-reference. –

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UW1389-W4 Rev. 04/06