Tax Exempt Certificate 499 - PDF - PDF

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					Form 499 R-4.1                                                                                                Commonwealth of Puerto Rico
Rev. 02.08
                                                                                                               Department of the Treasury

                                                                                       WITHHOLDING EXEMPTION CERTIFICATE
                                                                                              FOR EMPLOYEE'S USE
                                      READ INSTRUCTIONS ON REVERSE SIDE BEFORE FILLING OUT THIS WITHHOLDING EXEMPTION CERTIFICATE

  Fill out this form and file it with your employer. Otherwise, said employer is required by the Puerto Rico Internal Revenue Code of 1994, as amended (Code), to
  withhold your income tax without taking into account your personal exemption, exemption for dependents and allowance based on deductions.

                       ANY CHANGES IN THE PERSONAL EXEMPTION, THE NUMBER OF DEPENDENTS OR THE ALLOWANCE BASED ON DEDUCTIONS,
                                                     REQUIRE THE FILING OF AN AMENDED CERTIFICATE.

Employee's name                                                                                                               Employee's social security number


Spouse's name                                                                                                                 Spouse's social security number

Postal address                                                                                                                Home address




A. PERSONAL EXEMPTION                                                                                                                   Complete                                 Half                                None

     1. Single or married person not living with spouse

     2. Married person

     3. Head of household

B. EXEMPTION FOR DEPENDENTS

     NUMBER OF DEPENDENTS: _______________________

                                                                                                                                                     Automatic Method
C. ALLOWANCE BASED                                                                                                                                                                                                  Optional
   ON DEDUCTIONS                                                                                                                        Complete                                None                                Method

     1. Private business employee

     2. Governmental employee *

 * If you are a governmental employee, you must make a check mark to indicate if you participate in any of the following programs:
             Retirement Withholding Supplementary Plan
             Retirement Savings Accounts Program (Indicate the percentage that you elected as contribution ______%)

D. OPTIONAL COMPUTATION OF TAX
If you select the optional computation of tax in the case of married individuals living together, filing a joint return and both working, check here
(See instructions) ................................................................................................................................................................................................................
                                                                                                                OATH
I HEREBY CERTIFY that the personal exemption, exemption for dependents and the allowance based on deductions claimed herein, for purposes of withholding
of income tax from wages, do not exceed the amount that I am entitled to claim in the income tax return, according to the Code.

      ___________________________________                                                                                                                                                _________________
                Employee's signature                                                                                                                                                            Date
                                                                                                   FOR EMPLOYER'S USE
Indicate the number of allowances according to the method selected by the employee in Part C: ______________

(See instructions on back)
                                                                                                 Retention Period: Six (6) years
                                                                                       INSTRUCTIONS
The Withholding Exemption Certificate (Form 499 R-4.1) is the document used by employees to              *   If you make contributions to the governmental pension or retirement plan, your
notify his/her employer of the personal exemption, exemption for dependents and the allowance                employer shall add 8.275% of your annual wages, to the optional standard deduction
based on deductions. These three factors are considered to determine the income tax to be                    to which you are entitled. Then, the employer will divide that total by $500.
withheld from the employee’s wages.
                                                                                                         *   If you opted for the retirement supplementary plan, your employer will add to the
The employee shall complete the upper part of the form, indicating his/her name, social                      optional standard deduction 5.775% of your monthly wages up to $550 and 8.275%
security number, postal and home address. If married, indicate your spouse’s name and                        of your monthly wages in excess of such amount (on an annual basis). Then, the
social security number.                                                                                      employer will divide that total by $500.

Also, you shall indicate with an “X” in Part A your option regarding the personal exemption that         *   On the other hand, if the governmental employee makes contributions through the
you want to claim to determine the withholding from wages. Enter in Part B the number of                     Retirement Savings Accounts Program, your employer must add 8.275%, 9%,
dependents claimed, and in Part C your choice with respect to the allowance based on deductions.             9.5%, or 10% (as your option) of your annual wages, to the optional standard
In Part D indicate if you elect the optional computation of tax in the case of married individuals           deduction to which you are entitled. Then, your employer will divide that total by
living together, filing a joint return and both working (optional computation of tax), as provided           $500.
in Section 1011(d) of the Puerto Rico Internal Revenue Code of 1994, as amended (Code).
                                                                                                     The amount of the optional standard deduction allowable under the Code is:
PART A - PERSONAL EXEMPTION
                                                                                                     Married living with spouse..........................................................................      $3,150
Indicate the personal exemption that your employer will consider to determine the income             Married living with spouse filing separated returns ......................................                $1,575
tax to be withheld.                                                                                  Single or married not living with spouse …..................................................              $2,100
                                                                                                     Head of household......................................................................................   $2,730
Line 1 - A single person, or married not living with spouse, may claim or not the personal
exemption. If you want to claim the complete personal exemption, mark the column titled              If the governmental employee does not make contributions to a governmental pension or
“Complete”. On the other hand, if you choose to claim no exemption at all, you may do so by          retirement plan, the number of allowances will be determined in the same way as in the
marking the column titled “None”. A single person or married not living with spouse, cannot divide   case of private business employees.
in two halves his/her personal exemption.
                                                                                                     When both spouses receive wages subject to withholding and select the automatic method, they
Line 2 - Married couples are entitled to only one personal exemption, therefore, each spouse         must choose which of the spouses will select the optional standard deduction in order to determine
cannot claim the complete personal exemption. If you are a married person, and both spouses          the number of allowances. Nevertheless, if the married couple file a joint return and elected the
receive wages subject to withholding of income tax at source, both of you should agree on how        optional computation of tax, when determining the number of allowance based on deductions,
to claim the personal exemption and shall mark the corresponding column. If the married couple       each spouse will claim the standard deduction provided in Section 1023(aa)(1)(D) of the Code,
determine that only one of them will request the complete personal exemption, such spouse shall      that is, $1,575.
mark the column titled “Complete”. In such case, the other spouse shall mark the column titled
“None”. If you agreed with your spouse to divide the personal exemption in half, indicate so         Under the optional method, the number of allowances shall be determined as follows:
marking the column titled “Half”. If you do not want to claim the personal exemption, mark the
column titled “None”.                                                                                The total of itemized and additional deductions which you estimate you are entitled to claim
                                                                                                     will be divided by $500. The estimate of the deductions shall be made in form “Determination
Line 3 - As in the case of a single person, a head of household has two alternatives: claim          of Allowance Based on Deductions under the Optional Method” (Form 499 R-4B), which
the complete personal exemption or claim no personal exemption at all.                               shall be filed with your employer.

PART B - EXEMPTION FOR DEPENDENTS                                                                    Any fraction obtained as a result of this calculation in excess of 50%, shall be considered
                                                                                                     as an additional allowance.
Indicate the number of dependents claimed. It shall be the same as the number that you will
claim as dependents in your income tax return.                                                       In the case of a married person living with spouse, where both elect the optional method,
                                                                                                     they are entitled to determine the allowances based on their combined salaries and deductions.
In the case of an employee who elected the optional computation of tax, the exemption                They may divide the total allowances based on complete allowances. However, any
for dependents will be 50% of the total amount provided in Section 1025 of the Code, since           allowance claimed by one spouse, cannot be claimed by the other spouse.
in such cases each spouse is entitled to claim only half of the exemption for dependents, as
provided in Section 1011(d) of the Code.                                                             Nevertheless, if the married couple file a joint return, elect the optional computation of
                                                                                                     tax, and use this optional method to determine the allowance based on deductions, the
The Code provides that every employer who receives an exemption certificate from an                  number of allowances shall be determined by dividing the deductions among the spouses,
employee in which the number of dependents claimed exceeds 8, shall submit a copy                    as provided by Section 1011(d) of the Code. That is, the itemized deductions shall be
of such certificate to the Secretary of the Treasury, as well as a copy of any written               attributed to each spouse on a 50% basis of the total, and the additional deductions shall be
statement received from the employee to support the information contained in the certificate.        allowed to the spouse to whom they individually correspond, to the extent and subject to the
                                                                                                     provisions of subsection (bb) of Section 1023 of the Code.
PART C - ALLOWANCE BASED ON DEDUCTIONS
                                                                                                     EMPLOYERS USlNG THE WAGE BRACKET METHOD
You are entitled to certain allowances based on deductions which your employer shall
consider to determine the amount of income tax to be withheld.                                       lf the employer uses the withholding Wage Bracket Method, the number of allowances
                                                                                                     based on deductions under both the automatic or optional method, shall be determined by
The following two methods are provided in order to determine the number of allowances:               dividing the deductions by $2,500. For this purpose, only integer multiples of $2,500, and
   (1) automatic method                                                                              not the resulting fractions, will be considered.
   (2) optional method
                                                                                                     PART D - OPTIONAL COMPUTATION OF TAX
Under the automatic method, the number of allowances is determined as follows:
                                                                                                     For taxable years commencing after December 31, 2007, Section 1011(d) of the Code
(1) If you are a private business employee, your employer will divide the amount of the              provides an optional computation of tax in the case of married individuals living together,
    optional standard deduction to which you are entitled by $500.                                   filing a joint return and both working. An employee who elects to determine his/her tax using
                                                                                                     this computation, shall notify the same to his/her employer by checking the box provided in
(2) If you are a governmental employee, your employer shall consider the governmental                this part.
    pension or retirement plan to which you make contributions, if any:
 Form 499 R-4B                                                                                                     Commonwealth of Puerto Rico
 Rev. 02.08                                                                                                         Department of the Treasury
                                                                                          DETERMINATION OF ALLOWANCE BASED
                                                                                       ON DEDUCTIONS UNDER THE OPTIONAL METHOD
Employee's name                                                                                                                       Social security number

Employee's home address                                                                                                               Spouse's social security number

                                                                                                                                      If you select the optional computation of tax in the case of married individuals
                                                                                                                                      living together, filing a joint return and both working, check here
                                                                                                                                      (See instructions) ...........
                                                                                                 FOR EMPLOYEE'S USE ONLY
                                                          Select one alternative                                                                             Alternative 1                     Alternative 2
 1. Optional Standard Deduction .................................................................................................. (1)                                                                               00
 2. Estimated Itemized Deductions:
     a. Home mortgage interest ............................................................................................................ (2a)                                   00
     b. License plates for automobiles used for personal purposes........................................................ (2b)                                                     00
     c. Child care expenses ................................................................................................................. (2c)                                 00
     d. Expenses incurred in the care of elderly persons ...................................................................... (2d)                                               00
     e. Rent paid .................................................................................................................................. (2e)                          00
      f. Property tax on principal residence .......................................................................................... (2f)                                       00
     g. Casualty loss on your principal residence ................................................................................ (2g)                                            00
     h. Medical expenses .................................................................................................................... (2h)                                 00
      i. Charitable contributions............................................................................................................. (2i)                                00
      j. Loss of personal property as a result of certain casualties ........................................................... (2j)                                              00
     k. Windmills expenses .................................................................................................................. (2k)                                 00
      l. Expenses incurred in technological assistance equipment for handicapped persons, and for
         persons with specialized treatment or chronic disease ................................................................ (2 l)                                              00
     m. Dependent's education expenses ............................................................................................. (2m)                                          00
     n. Solar equipment expenses ....................................................................................................... (2n)                                      00
     o. Interest paid on students loans at university level ...................................................................... (2o)                                            00
     p. Contributions to the Fund for Services Against Remediable Catastrophic Diseases ................... (2p)                                                                   00
     q. Total estimated itemized deductions .................................................................................. (2q)                                                00
 3. Enter 50% of total estimated itemized deductions .................................................................. (3)                                                        00
 4. Estimated Additional Deductions:
     a. Contributions to Individual Retirement Accounts ........................................................................ (4a)                                              00                               00
     b. Contributions to governmental pension or retirement systems ................................................... (4b)                                                       00                               00
     c. Deduction when both spouses work (filing a joint return) ........................................................... (4c)                                                  00                               00
     d. Veterans ................................................................................................................................... (4d)                          00                               00
     e. Ordinary and necessary expenses .......................................................................................... (4e)                                            00                               00
      f. Automobile loan interest (up to $1,200)....................................................................................... (4f)                                       00                               00
     g. Young people who work .......................................................................................................... (4g)                                      00                               00
     h. Educational Contributions Account ............................................................................................ (4h)                                        00                               00
      i. Acquisition and installation of a personal computer used by dependents ................................... (4i)                                                           00                               00
      j. Total estimated additional deductions ............................................................................... (4j)                                                00                               00
 5. Add total estimated itemized deductions (line 2(q) or 3, as applicable) and total estimated additional
    deductions (See instructions)............................................................................................................ (5)                                  00
 6. Add the optional standard deduction and estimated additional deductions...................................... (6)                                                                                               00
 7. Number of allowances under Alternative 1 (Line 5 divided by $500) ............................................... (7)
 8. Number of allowances under Alternative 2 (Line 6 divided by $500) ............................................... (8)
 9. Allowances that you want to claim under Alternative 1 (From the total of line 7) ................................... (9)
10. Allowances that you want to claim under Alternative 2 (From the total of line 8) ................................... (10)
                                                                                                                   OATH
  I declare under the penalty of perjury that I have examined this form, and to the best of my knowledge, the information contained herein is true, correct and complete.

    _______________________________________                                                                                                                                 ________________________
                Employee's signature                                                                                                                                                  Date
                                                                                                FOR EMPLOYER'S USE ONLY
   (i) Number of Allowances (Under the Percentage Method) (Line 9 or 10) ...................................................................................................
   (ii) Number of Allowances (Under the Wage Bracket Method) (Line 9 or 10 multiplied by $500 and divided by $2,500) .....................................
                                                                                                     Retention Period: Six (6) years
                                                                                                          INSTRUCTIONS
This form has been developed to be used by those employees who indicate in Part C of the                                 To determine the estimated deduction for Medical Expenses and Charitable Contributions (lines
Withholding Exemption Certificate (Form 499 R-4.1), their preference for the Optional Method                             2(h) and 2(i), respectively), you shall consider the restrictions and limitations provided by the
in order to determine their allowances based on deductions.                                                              Code.

The employee shall provide on the upper part of this Form 499 R-4B the following information:                            Line 3 – Enter 50% of the total estimated itemized deductions
name, home address, your and your spouse’s social security number, and indicate if you elect
the optional computation of tax in the case of married individuals living together, filing a joint return                Use this line (Alternative 1) to determine the 50% of estimated itemized deductions, if you file a
and both working (optional computation of tax), as provided by Section 1011(d) of the Puerto                             joint return and elect the optional computation of tax. Section 1011(d) of the Code provides
Rico Internal Revenue Code of 1994, as amended (Code).                                                                   that itemized deductions shall be attributed to each spouse on a 50% basis of the total.
GENERAL PROVISIONS
                                                                                                                         Line 4 – Estimated Additional Deductions
The Code allows the taxpayers as part of the withholding exemption, in addition to the personal
exemption and the exemption for dependents, an allowance based on deductions. In order to                                Enter in the corresponding column the additional deductions you will be entitled to deduct, as
determine the number of allowances based on deductions, the following two methods are                                    applicable (lines 4(a) through 4(i)). Enter the total on line 4(j).
provided: (1) the Automatic Method and (2) the Optional Method.
                                                                                                                         Line 5 – Sum of total estimated itemized and additional deductions
Under the Automatic Method, the number of allowances based on deductions is determined
following the instructions appearing on the reverse side of the Withholding Exemption Certificate                        If you have elected Alternative 1, add the estimated total of the itemized deductions (line 2(q) or
(Form 499 R-4.1).                                                                                                        3 of the first column, as applicable) and additional deductions (line 4(j), first column) that you are
                                                                                                                         entitled to claim.
Under the Optional Method, the number of allowances based on deductions will be determined
according to one of the following alternatives:                                                                          Line 6 – Sum of optional standard deduction and estimated additional deductions

Alternative 1: The approximate total of deductions that you estimate you will be entitled to                             If you have elected Alternative 2, add the optional standard deduction (line 1, second column) and
deduct when computing your net income for the corresponding taxable year, for the itemized and                           the total estimated additional deductions (line 4(j), second column) that you are entitled to claim.
additional deductions, divided by $500, or
                                                                                                                         Line 7 – Number of allowances under Alternative 1
Alternative 2: The total optional standard deduction that you are entitled to deduct, plus the
approximate total of the additional deductions that you estimate you will be entitled to deduct                          Divide the amount figured on line 5 by $500 and enter the result on this line. Any fraction obtained
when computing your net income for a taxable year, divided by $500.                                                      as a result of the preceding division exceeding 50%, shall be considered as an additional
                                                                                                                         allowance.
In the case of a married couple filing a joint return and both spouses receive wages subject to
withholding of income tax at source, and elect the Optional Method, they are entitled to determine                       Line 8 - Number of allowances under Alternative 2
the number of allowances based on deductions considering their combined deductions. The
spouses may divide between them the total allowances as they choose, but such election shall                             Divide the amount figured on line 6 by $500 and enter the result on this line. Any fraction obtained
be based on complete allowances. Notwithstanding, any allowance claimed by one of the                                    as a result of the preceding division exceeding 50%, shall be considered as an additional
spouses shall not be claimed by the other. In such cases, each spouse shall fill out Form 499                            allowance.
R-4B, with the same information on every line, except on line 9 (if they elect Alternative 1), or line
10 (if both elect Alternative 2), where each spouse shall indicate to his or her employer the                            Lines 9 and 10 – Allowances that you want to claim under Alternative 1 or 2
number of allowances, previously figured on line 7 or 8, that he or she wish to consider for
withholding exemption purposes.                                                                                          After carrying out the mathematical operation indicated on line 7 or 8, you shall indicate on line 9
                                                                                                                         or 10, the number of allowances that you wish to consider for withholding exemption purposes.
Nevertheless, if the married couple file a joint return, elect the optional computation of tax,                          However, if you elect the optional computation of tax, you shall use the number of allowances
and use this Optional Method to determine the allowance based on deductions, the number of                               determined on lines 7 or 8.
allowances shall be determined by dividing the deductions among the spouses, as provided by                              OATH
Section 1011(d) of the Code. That is, the itemized deductions shall be attributed to each spouse
on a 50% basis of the total (line 3, Alternative 1), and the additional deductions (line 4) shall be                     You declare under penalty of perjury, that you have examined this form, and that to the best of
allowed to the spouse to whom they individually correspond, to the extent and subject to the                             your knowledge, the information contained therein is true, correct and complete.
provisions of subsection (bb) of Section 1023 of the Code. In this way, the spouses may take as
                                                                                                                         SIGNATURE
the basis to determine the allowances, the deductions they are entitled to claim individually. Like
this, any allowance claimed by one spouse cannot be claimed by the other spouse. It is                                   This form must be signed and dated by the employee.
important that when each spouse fill out Form 499 R-4B, check the box to indicate that he or she
                                                                                                                         PENALTIES
elects the optional computation of tax.
                                                                                                                         Any employee required to submit a withholding exemption certificate to his or her employer, who
On the other hand, in the case of married persons living with spouse and filing separate returns,                        willfully provides false or fraudulent information, or who willfully fails to provide information which
where both spouses receive wages subject to withholding of income tax at source, they shall                              would require an increase in the tax to be withheld, shall be guilty of a misdemeanor.
elect the same alternative under the Optional Method and each one shall complete a Form 499
R-4B, indicating the amount of total deductions he or she is entitled to deduct.                                         In the case of employees who elect the Optional Method, in addition to the criminal penalty
                                                                                                                         mentioned in the above paragraph, if the 70% of tax attributable to income derived from wages
SPECIFIC INSTRUCTIONS                                                                                                    subject to withholding exceeds the tax withheld at source on said income, there shall be added
Line 1 – Optional Standard Deduction                                                                                     to the tax the smaller of: (1) an amount equal to such excess, or (2) an amount equal to 18% of
                                                                                                                         the amount for which such tax so determined exceeds the tax withheld.
Enter the standard deduction corresponding to your personal status, if you elected Alternative 2                         INSTRUCTIONS TO THE EMPLOYER
to determine the allowances. The total amount of the optional standard deduction allowable under
the Code is the following:                                                                                               Employers using the Percentage Method, shall indicate on line (i) the number of allowances
                                                                                                                         figured by the employee on line 9 (if the employee elected Alternative 1), or on line 10 (if the
      Married person living with spouse and filing jointly .......................................... $3,150
                                                                                                                         employee elected Alternative 2).
      Head of household ....................................................................................... $2,730
      Single or married person not living with spouse ............................................... $2,100
                                                                                                                         Employers using the Wage Bracket Method, shall determine the number of allowances multiplying
      Married person living with spouse and filing separately ..................................... $1,575
                                                                                                                         the number of allowances figured by the employee on line 9 or 10 by $500, and dividing the result
Nevertheless, if the married couple file a joint return and elects the optional computation of                           by $2,500. To make easier the use of these tables, each allowance was incorporated to them on
tax, the standard deduction will be the one provided in Section 1023(aa)(1)(D) of the Code for                           the basis of $2,500, which is equivalent to the amount allowable as exemption for dependents.
married person filing separately, that is, $1,575.                                                                       The number of allowances so determined, shall be entered on line (ii). Any fraction obtained as
                                                                                                                         a result of the previous division, shall not be considered as an additional allowance.
Line 2 – Estimated Itemized Deductions
                                                                                                                         The employer must transfer to the corresponding line of the Withholding Exemption Certificate
Enter the estimated itemized deductions as applicable (lines 2(a) through 2(p)), if you elected                          (Form 499 R-4.1), the number of allowances indicated on line (i) (if the Percentage Method is
Alternative 1 for the computation of the allowances. Enter the total allowances on line 2(q).                            used), or on line (ii) (if the Wage Bracket Method is used), as applicable.

				
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