CA – Horizons Portal

Filing Status Withholding Allowances
- SINGLE or MARRIED (with two or more incomes)
- MARRIED (one income)
- HEAD OF HOUSEHOLD

Download W4 Instructions
SECTION 1

Fill out Section 1 OR Section 2 OR Section 3)
Number of allowances for Regular Withholding Allowances, Worksheet A
Number of allowances from the Estimated Deductions, Worksheet B
Total Number of Allowances (A + B) when using the California Withholding Schedules for 2019
SECTION 2
Additional amount of state income tax to be withheld each pay period (if employer agrees), Worksheet C
SECTION 3
I certify under penalty of perjury that I am not subject to California withholding. I meet the conditions set forth under the Service Member Civil Relief Act, as amended by the Military Spouses Residency Relief Act.
- Not Subject to California Withholding

Under penalties of perjury, I certify that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete.*
- I certify the above statement
Social Security Number*
Employee Signature – Type Your Name*
Today's Date*
My IP Address is: 44.192.115.114
This form was submitted on: 09/21/2023

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