Georgia Form G-4 (Employee Withholding) (2024)

Employee Withholding
Form G-4
PRINTCLEARForm G-4 (Rev. 12/27/23)STATE OF GEORGIA EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE1a. YOUR FULL NAME1b. YOUR SOCIAL SECURITY NUMBER2a. HOME ADDRESS (Number, Street, or Rural Route)2b. CITY, STATE AND ZIP CODEPLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING LINES 3 – 83. MARITAL STATUSEnter letter below on Line 7.4. DEPENDENT ALLOWANCES[]A. SingleB. Married Filing Separate or Married Filing Joint, both spouses workingC. Married Filing Joint, one spouse workingD. Head of Household5. GEORGIA ADJUSTMENTS ALLOWANCE [ ](See instructions for details. Worksheet below mustbe completed)6. ADDITIONAL WITHHOLDING$____________WORKSHEET FOR CALCULATING ADDITIONAL ALLOWANCES(Must be completed for step 5)A. Federal Estimated Itemized Deductions (If Itemizing Deductions)............................. $______________B. Georgia Standard Deduction (enter one):$______________Single/Head of Household ................................$12,000................................$24,000Married Filing Joint................................$12,000Married Filing SeparateC. Subtract Line B from Line A (If zero or less, enter zero) ....................................................................$______________D. Allowable Georgia Adjustments to Federal Adjusted Gross Income .....................................................$______________E. Add the Amounts on Lines C and D ...................................................................................................$______________F. Estimate of Taxable Income not Subject to Withholding ...................................................................$______________G. Subtract Line F from Line E (if zero or less, stop here).......................................................................$______________H. Divide the Amount on Line G by $3,000. Enter total here and on Line 5 above ...................................______________(This is the number of Georgia Adjustments Allowances you can claim. If the remainder is over $1,500 round up)7. LETTER USED (Marital Status A, B, C or D) ___________TOTAL ALLOWANCES (Total of Lines 4 - 5) ___________(Employer: The letter indicates the tax tables in Employer’s Tax Guide)8. EXEMPT: (Do not complete Lines 4 - 7 if claiming exempt) Read the Line 8 instructions on page 2 before completing this section.a) I claim exemption from withholding because I incurred no Georgia income tax liability last year and I do not expect tohave a Georgia income tax liability this year. Check hereb) I certify that I am not subject to Georgia withholding because I meet the conditions set forth under the ServicemembersCivil Relief Act as provided on page 2. My state of residence is ________________. My spouse’s (servicemember) stateof residence is ________________ . The states of residence must be the same to be exempt. Check hereI certify under penalty of perjury that I am entitled to the number of withholding allowances or the exemption from withholding statusclaimed on this Form G-4. Also, I authorize my employer to deduct per pay period the additional amount listed above.Employee’s Signature________________________________________________________ Date _________________Employer: Complete Line 9 and mail entire form only if the employee claims over 14 allowances or exempt from withholding.If necessary, mail form to: Georgia Department of Revenue, Taxpayer Services Division, P.O. Box 105499, Atlanta, GA 303599. EMPLOYER’S NAME AND ADDRESS:EMPLOYER’S FEIN:____________________________EMPLOYER’S WH#:____________________________Do not accept forms claiming additional allowances unless the worksheet has been completed. Do not accept formsclaiming exempt if numbers are written on Lines 4 - 7.PRINTCLEARG-4 (Rev. 12/27/23)INSTRUCTIONS FOR COMPLETING FORM G-4Enter your full name, address and social security number in boxes 1a through 2b.Line 3: Write the letter on Line 7 according to your marital status.A.B.C.D.SingleMarried Filing Separate or Married Filing Joint, both spouses workingMarried Filing Joint, one spouse workingHead of HouseholdLine 4: Enter the number of dependent allowances you are entitled to claim. The term "dependent" shall have the same meaning as in theInternal Revenue Code of 1986; provided, however, that any unborn child with a detectable human heartbeat, as such terms aredefined in Code Section 1-2-1, shall qualify as a dependent minor.Line 5: Complete the worksheet on Form G-4 if you claim Georgia adjustments Allowances. Enter the number from Line H here.Failure to complete and submit the worksheet will result in automatic denial on your claim.Line 6: Enter a specific dollar amount that you authorize your employer to withhold in addition to the tax withheld based on yourmarital status and number of allowances.Line 7: Enter the letter of your marital status from Line 3. Enter total of the numbers on Lines 4-5.Line 8:a)Check the first box if you qualify to claim exempt from withholding. You can claim exempt if you filed a Georgia income taxreturn last year and the amount of Line 4 of Form 500EZ or Line 16 of Form 500 was zero, and you expect to file a Georgiatax return this year and will not have a tax liability. You cannot claim exempt if you did not file a Georgia income tax returnfor the previous tax year. Receiving a refund in the previous tax year does not qualify you to claim exempt.EXAMPLES: Your employer withheld $500 of Georgia income tax from your wages. The amount on Line 4 of Form 500EZ(or Line 16 of Form 500) was $100. Your tax liability is the amount on Line 4 (or Line 16); therefore, you do not qualify toclaim exempt.Your employer withheld $500 of Georgia income tax from your wages. The amount on Line 4 of Form 500EZ (or Line 16 ofForm 500) was $0 (zero). Your tax liability is the amount on Line 4 (or Line 16) and you filed a prior year income tax return;therefore you qualify to claim exempt.b)Check the second box if you are not subject to Georgia withholding and meet the conditions set forth under theServicemembers Civil Relief Act. Under the Act, a spouse of a servicemember may be exempt from Georgia income tax onincome from services performed in Georgia if:1. The servicemember is present in Georgia in compliance with military orders;2. The spouse is in Georgia solely to be with the servicemember;3. The servicemember maintains domicile in another state; and4. The domicile of the spouse is the same as the domicile of the servicemember or the spouse of the servicemember haselected to use the same residence for purposes of taxation as the servicemember.Additional information for employers regarding the Military Spouses Residency Relief Act:1. On the W-2 the employer should not report any of the wages as Georgia wages.2. If the spouse of a servicemember is entitled to the protection of the Military Spouses Residency Relief Act in anotherstate and files a withholding exemption form in such other state, the spouse is required to submit a Georgia Form G-4so that withholding will occur as is required by Georgia Law when a Georgia domiciliary works in another state andwithholding is not required by such other state. If the spouse does not fill out the form, the employer shall withholdGeorgia income tax as if the spouse is single with zero allowances.Worksheet for calculating additional allowances. Enter the information as requested by each line. For Line D, enter items suchas Retirement Income Exclusion, U.S. Obligations, and other allowable deductions per Georgia Law, see the IT-511 booklet formore information.Do not complete Lines 4-7 if claiming exempt.O.C.G.A. § 48-7-102 requires you to complete and submit Form G-4 to your employer in order to have tax withheld from yourwages. By correctly completing this form, you can adjust the amount of tax withheld to meet your tax liability. Failure to submit aproperly completed Form G-4 will result in your employer withholding tax as though you are single with zero allowances.Employers are required to mail any Form G-4 claiming more than 14 allowances or exempt from withholding to the GeorgiaDepartment of Revenue. Employers should honor the properly completed form as submitted unless otherwise notified by theDepartment. Such forms remain in effect until changed or until February 15 of the following year. Employers who know that aG-4 is erroneous should not honor the form and should withhold as if the employee is single claiming zero allowances until acorrected form has been received.

Extracted from PDF file 2023-georgia-form-g-4.pdf, last modified January 2013

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