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
Error! Not a valid
bookmark self-reference. –
Error! Not a valid bookmark self-reference. . For more information contact your Payroll office.
Error! Not a valid
bookmark self-reference. –
Error! Not a valid
bookmark self-reference.
UW1389-W4 Rev. 04/06