Common use of Additional Withholding Clause in Contracts

Additional Withholding. If you have claimed “zero” exemptions on line 1, but still expect to have a balance due on your tax return for the year, you may wish to request your employer to withhold an additional amount of tax for each pay period. If your employer agrees to this additional withholding, enter the additional amount you want deducted from each of your paychecks on line 2. • LINE 3: Exemption from withholding – You may claim exemption from withholding of Wisconsin income tax if you had no liability for income tax for last year, and you expect to incur no liability for income tax for this year. You may not claim exemption if your return shows tax liability before the allowance of any credit for income tax withheld. If you are exempt, your employer will not withhold Wisconsin income tax from your wages. You must revoke this exemption (1) within 10 days from the time you expect to incur income tax liability for the year or (2) on or before December 1 if you expect to incur Wisconsin income tax liabilities for the next year. If you want to stop or are required to revoke this exemption, you must complete and provide a new Form WT‑4 to your employer showing the number of withholding exemp‑ tions you are entitled to claim. This certificate for exemption from withholding will expire on April 30 of next year unless a new Form WT‑4 is completed and provided to your employer before that date. Employer’s name Federal Employer ID Number Employer’s payroll address (number and street) City State Zip code Completed by Title Phone number ( ) Email EMPLOYER INSTRUCTIONS for Department of Revenue: EMPLOYER INSTRUCTIONS for New Hire Reporting:• If you do not have a Federal Employer Identification Number (FEIN), contact • This report contains the required information for reporting a New Hire to the Internal Revenue Service to obtain a FEIN. Wisconsin. If you are reporting new hires electronically, you do not need to • If the employee has claimed more than 10 exemptions OR has claimed com‑ forward a copy of this report to the Department of Workforce Development. plete exemption from withholding and earns more than $200.00 a week or is Visit ▇▇▇▇▇://▇▇▇.▇▇.▇▇▇/uinh/ to report new hires. believed to have claimed more exemptions than they are entitled to, mail a • If you do not report new hires electronically, mail the original form to the Depart‑ copy of this certificate to: Wisconsin Department of Revenue, Audit Bureau, ment of Workforce Development, New Hire Reporting, ▇▇ ▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇ or fax (608) 267‑0834. WI 53708‑0431 or fax toll free to 1‑800‑277‑8075. • Keep a copy of this certificate with your records. If you have questions about the • If you have questions about New Hire requirements, call toll free (888) 300‑HIRE Department of Revenue requirements, call (608) 266‑2772 or (608) 266‑2776. (888‑300‑4473). Visit ▇▇▇.▇▇.▇▇▇/▇▇▇▇/ for more information. W‑204 (R. 8‑23) Wisconsin Department of Revenue This document provides statements or interpretations of the following laws and regulations enacted as of August 23, 2023: sec. 71.66, Wis. Stats., and sec. Tax 2.92, Wis. Adm. Code. The address will be displayed appropriately in a left window envelope. Division of Quality Assurance F-82064 (01/2022) • PENALTY: A person who provides false information on this form may be subject to forfeiture and sanctions, as provided in Wis. Stat. § 50.065(6)(c) and Wis. Admin Code § DHS 12.05(4). • Completion of this form to verify your eligibility for employment/service as a “caregiver” is required by Wis. Stat. § 50.065 and Wis. Admin Code ch. DHS 12. Failure to complete this form may result in denial or termination of your employment, contract or service agreement. Refer to DQA form F-82064A, Instructions, for additional information. Applicant / Employee Student / Volunteer Contractor Other – Specify: NOTE: This form should NOT be used by applicants for entity operator approval (license, certification, registration or other DHS approval) or by entities requesting approval for an individual to reside in entity facilities as a non-client resident. Applicants for entity operator approval or for a non-client resident background check must request an entity background check from the Division of Quality Assurance. Full Legal Name – First Middle Last Other Names (including prior to marriage) Position Title ( applied for or existing) Birth Date (MM/DD/YYYY) / / Sex Male Female Home Address City State Zip Code Business Name and Address – Employer (Entity)

Additional Withholding. If you have claimed “zero” exemptions on line 1, but still expect to have a balance due on your tax return for the year, you may wish to request your employer to withhold an additional amount of tax for each pay period. If your employer agrees to this additional withholding, enter the additional amount you want deducted from each of your paychecks on line 2. • LINE 3: Exemption from withholding – You may claim exemption from withholding of Wisconsin income tax if you had no liability for income tax for last year, and you expect to incur no liability for income tax for this year. You may not claim exemption if your return shows tax liability before the allowance of any credit for income tax withheld. If you are exempt, your employer will not withhold Wisconsin income tax from your wages. You must revoke this exemption (1) within 10 days from the time you expect to incur income tax liability for the year or (2) on or before December 1 if you expect to incur Wisconsin income tax liabilities for the next year. If you want to stop or are required to revoke this exemption, you must complete and provide a new Form WT‑4 to your employer showing the number of withholding exemp‑ tions you are entitled to claim. This certificate for exemption from withholding will expire on April 30 of next year unless a new Form WT‑4 is completed and provided to your employer before that date. Employer’s name Federal Employer ID Number Employer’s payroll address (number and street) City State Zip code Completed by Title Phone number ( ) Email EMPLOYER INSTRUCTIONS for Department of Revenue: EMPLOYER INSTRUCTIONS for New Hire Reporting:• If you do not have a Federal Employer Identification Number (FEIN), contact • This report contains the required information for reporting a New Hire to the Internal Revenue Service to obtain a FEIN. Wisconsin. If you are reporting new hires electronically, you do not need to • If the employee Employee has claimed more than 10 exemptions OR has claimed com‑ forward a copy of this report to the Department of Workforce Development. plete complete exemption from withholding and earns more than $200.00 a week or is Visit ▇▇▇▇▇://▇▇▇.▇▇.▇▇▇/uinh/ to report new hires. or is believed to have claimed more exemptions than they are he or she is entitled to, mail a • If you do not report new hires electronically, mail the original form to the Depart‑ mail a copy of this certificate to: Wisconsin Department of Revenue, Audit Bureau, ment of Workforce Development, New Hire Reporting, ▇▇ ▇▇▇ ▇▇▇▇▇PO Box 14431, ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇Madison Bureau, ▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇ PO Box 8906, Madison WI 53708 or fax (608) 267‑0834. WI 53708‑0431 or fax toll free to 1‑800‑277‑8075. • Keep a copy of this certificate with your records. If you have questions about the • If you have questions about New Hire requirements, call toll free (888) 300‑HIRE Department of Revenue requirements, call (608) 266‑2772 or (608) 266‑2776. (888‑300‑4473). Visit ▇▇▇.▇▇.▇▇▇/▇▇▇▇/ for more information. W‑204 (R. 8‑2310‑19) Wisconsin Department of Revenue This document provides statements or interpretations of the following laws and regulations enacted in effect as of August 23January 1, 2023: sec. 71.66, Wis. Stats., and sec. Tax 2.92, Wis. Adm. Code. The address will be displayed appropriately in a left window envelope. Division of Quality Assurance F-82064 (01/2022) • PENALTY: A person who provides false information on this form may be subject to forfeiture and sanctions, as provided in Wis. Stat. § 50.065(6)(c) and Wis. Admin Code § DHS 12.05(4). • Completion of this form to verify your eligibility for employment/service as a “caregiver” is required by Wis. Stat. § 50.065 and Wis. Admin Code ch. DHS 12. Failure to complete this form may result in denial or termination of your employment, contract or service agreement. Refer to DQA form F-82064A, Instructions, for additional information. Applicant / Employee Student / Volunteer Contractor Other – Specify: NOTE: This form should NOT be used by applicants for entity operator approval (license, certification, registration or other DHS approval) or by entities requesting approval for an individual to reside in entity facilities as a non-client resident. Applicants for entity operator approval or for a non-client resident background check must request an entity background check from the Division of Quality Assurance. Full Legal Name – First Middle Last Other Names (including prior to marriage) Position Title ( applied for or existing) Birth Date (MM/DD/YYYY) / / Sex Male Female Home Address City State Zip Code Business Name and Address – Employer (Entity)2019:

Additional Withholding. If you have claimed “zero” exemptions on line 1, but still expect to have a balance due on your tax return for the year, you may wish to request your employer to withhold an additional amount of tax for each pay period. If your employer agrees to this additional withholding, enter the additional amount you want deducted from each of your paychecks on line 2. • LINE 3: Exemption from withholding – You may claim exemption from withholding of Wisconsin income tax if you had no liability for income tax for last year, and you expect to incur no liability for income tax for this year. You may not claim exemption if your return shows tax liability before the allowance of any credit for income tax withheld. If you are exempt, your employer will not withhold Wisconsin income tax from your wages. You must revoke this exemption (1) within 10 days from the time you expect to incur income tax liability for the year or (2) on or before December 1 if you expect to incur Wisconsin income tax liabilities for the next year. If you want to stop or are required to revoke this exemption, you must complete and provide a new Form WT‑4 to your employer showing the number of withholding exemp‑ tions you are entitled to claim. This certificate for exemption from withholding will expire on April 30 of next year unless a new Form WT‑4 is completed and provided to your employer before that date. Employer’s name Federal Employer ID Number Employer’s payroll address (number and street) City State Zip code Completed by Title Phone number ( ) Email EMPLOYER INSTRUCTIONS for Department of Revenue: EMPLOYER INSTRUCTIONS for New Hire Reporting:• If you do not have a Federal Employer Identification Number (FEIN), contact • This report contains the required information for reporting a New Hire to the Internal Revenue Service to obtain a FEIN. Wisconsin. If you are reporting new hires electronically, you do not need to • If the employee has claimed more than 10 exemptions OR has claimed com‑ forward a copy of this report to the Department of Workforce Development. plete exemption from withholding and earns more than $200.00 a week or is Visit ▇▇▇▇▇://▇▇▇.▇▇.▇▇▇/uinh/ to report new hires. believed to have claimed more exemptions than they are entitled to, mail a • If you do not report new hires electronically, mail the original form to the Depart‑ copy of this certificate to: Wisconsin Department of Revenue, Audit Bureau, ment of Workforce Development, New Hire Reporting, ▇▇ ▇▇▇ ▇▇▇▇▇PO Box 14431, ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇Madison PO Box 8906, ▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇ Madison WI 53708 or fax (608) 267‑0834. WI 53708‑0431 or fax toll free to 1‑800‑277‑8075. • Keep a copy of this certificate with your records. If you have questions about the • If you have questions about New Hire requirements, call toll free (888) 300‑HIRE Department of Revenue requirements, call (608) 266‑2772 or (608) 266‑2776. (888‑300‑4473). Visit ▇▇▇.▇▇.▇▇▇/▇▇▇▇/ for more information. W‑204 (R. 8‑23) Wisconsin Department of Revenue This document provides statements or interpretations of the following laws and regulations enacted as of August 23, 2023: sec. 71.66, Wis. Stats., and sec. Tax 2.92, Wis. Adm. Code. The address will be displayed appropriately in a left window envelope. Division of Quality Assurance F-82064 (01/2022) • PENALTYU.S. Citizenship and Immigration Services START HERE: A person who provides false Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions. ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on this form their citizenship, immigration status, or national origin may be subject to forfeiture and sanctions, as provided in Wis. Stat. § 50.065(6)(c) and Wis. Admin Code § DHS 12.05(4). • Completion of this form to verify your eligibility for employment/service as a “caregiver” is required by Wis. Stat. § 50.065 and Wis. Admin Code ch. DHS 12. Failure to complete this form may result in denial or termination of your employment, contract or service agreement. Refer to DQA form F-82064A, Instructions, for additional information. Applicant / Employee Student / Volunteer Contractor Other – Specify: NOTE: This form should NOT be used by applicants for entity operator approval (license, certification, registration or other DHS approval) or by entities requesting approval for an individual to reside in entity facilities as a non-client resident. Applicants for entity operator approval or for a non-client resident background check must request an entity background check from the Division of Quality Assurance. Full Legal Name – First Middle Last Other Names (including prior to marriage) Position Title ( applied for or existing) Birth Date (MM/DD/YYYY) / / Sex Male Female Home Address City State Zip Code Business Name and Address – Employer (Entity)illegal.