GA – Horizons Portal

MARITAL STATUS
Download W4 Instructions
If you do not wish to claim an allowance, enter “0” in the brackets beside your marital status.
A. Single: Enter 0 or 1
B. Married Filing Joint, both spouses working: Enter 0 or 1
C. Married Filing Joint, one spouse working: [ ] Enter 0 or 1 or 2
D. Married Filing Separate: Enter 0 or 1
E. Head of Household: Enter 0 or 1
Allowances
4. DEPENDENT ALLOWANCES
5. ADDITIONAL ALLOWANCES
6. ADDITIONAL WITHHOLDING AMOUNT

Worksheet
WORKSHEET FOR CALCULATING ADDITIONAL ALLOWANCES

(Must be completed in order to enter an amount on step 5)
1. COMPLETE THIS LINE ONLY IF USING STANDARD DEDUCTION
- Yourself: 65 or Over
- Yourself: Blind
- Spouse: 65 or Over
- Spouse: Blind
2. ADDITIONAL ALLOWANCES FOR DEDUCTIONS:
Number of boxes checked
Number of Boxes Checked X $1300
A. Federal Estimated Itemized Deductions (If Itemizing Deductions)
B. Federal Estimated Itemized Deductions (If Itemizing Deductions) Single/Head of Household $4600 Each Spouse $3000
C. Subtract Line B from Line A (If zero or less, enter zero)
D. Allowable Deductions to Federal Adjusted Gross Income
E. Add the Amounts on Lines 1, 2C, and 2D
F. Estimate of Taxable Income not Subject to Withholding
G. Subtract Line F from Line E (if zero or less, stop here)
Divide the Amount on Line G by $3,000. Enter total here and on Line 5 above

7. LETTER USED (Marital Status A, B, C, D, or E)
TOTAL ALLOWANCES (Total of Lines 3 – 5)
8a. EXEMPT: (Do not complete Lines 3 – 7 if claiming exempt)
- No Georgia income tax liability
8b) I certify that I am not subject to Georgia withholding because I meet the conditions set forth under the Service Members Civil Relief Act as provided on page 2.
My state of residence is
My spouse’s (service member) state of residence is
The states of r esidence must be the same to be exempt
- Check Here

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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