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Rhode Island W4
Employee’s Withholding Allowance Certificate
Download W4 Instructions
Rhode Island W4
Step
1
of
3
33%
Name
*
First
Middle
Last
Email
*
Address
*
Street Address
Address Line 2
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Download W4 Instructions
1. Enter the number of allowances from line 1E on worksheet
2. Enter any additional dollar amount which you would like withheld from your pay
3. If you meet the conditions above, write “EXEMPT” or “EXEMPT-MS” whichever applies
Employee: File this form with your employer to adjust your Rhode Island withholding. You should make a copy for your own records.
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
*
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My IP Address is: 44.192.115.114 This form was submitted on: 09/21/2023
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