Appendix X: Certificate of Exemption from Withholding

 
 
            CERTIFICATE OF EXEMPTION FROM WITHHOLDING IN LIEU OF W-4 
 
        Consistent and  in pari  materia  with  Section  3402(n)  of  the 
        Internal Revenue  Code, shown herewith, I hereby certify to being 
        EXEMPT by law from all federal income tax withholdings because: 
 
        A.   No liability  for income  tax has knowingly been incurred by 
             me under Subtitle A in the past year or in previous years. 
 
        B.   No liability for income tax will knowingly be incurred by me 
             under Subtitle A in the current year or in future years. 
 
        Effective immediately, stop all federal tax withholdings. 
 
        Thank you for your consideration. 
 
        With Explicit Reservation of All My Unalienable Rights 
        and  Without Prejudice to Any of My Unalienable Rights 
 
 
        Signed: _________________________________________________________ 
 
        Name: ___________________________________________________________ 
 
        Address: ________________________________________________________ 
 
        County of: ______________________________________________________ 
 
        State of: _______________________________________________________ 
 
 
                     California All-Purpose Acknowledgement 
 
        CALIFORNIA STATE/REPUBLIC       ) 
                                        ) 
        COUNTY OF MARIN                 ) 
 
             On the  ________ day  of  ____________,  199_  Anno  Domini, 
        before me personally appeared John Q. Doe, personally known to me 
        (or proved to me on the basis of satisfactory evidence) to be the 
        Person whose  name is  subscribed to  the within  instrument  and 
        acknowledged to  me that  he executed  the same in His authorized 
        capacity, and  that by  His  signature  on  this  instrument  the 
        Person, or  the entity  upon behalf  of which  the Person  acted, 
        executed the  instrument.    Purpose  of  Notary  Public  is  for 
        identification only,  and  not  for  entrance  into  any  foreign 
        jurisdiction. 
 
        WITNESS my hand and official seal. 
 
 
 
        _____________________________________ 
        Notary Public 
 
 
        Internal Revenue Code, Section 3402(n): 
 
        (n)  Employees Incurring No Income Tax Liability. -- 
 
             Notwithstanding any  other provision  of  this  section,  an 
             employer shall  not be  required to  deduct and withhold any 
             tax under  this chapter  upon  a  payment  of  wages  to  an 
             employee if  there is in effect with respect to such payment 
             a  withholding  exemption  certificate  (in  such  form  and 
             containing such  other  information  as  the  Secretary  may 
             prescribe)  furnished   to  the  employer  by  the  employee 
             certifying that the employee -- 
 
 
             (1)  incurred no  liability for  income  tax  imposed  under 
                  Subtitle A for his preceding taxable year, and 
 
             (2)  anticipates that  he will incur no liability for income 
                  tax imposed  under Subtitle  A for  his current taxable 
                  year. 
 
 
             The  Secretary   shall  by   regulations  provide   for  the 
             coordination of  the provisions  of this subsection with the 
             provisions of subsection (f). 
 
                                                            [IRC 3402(n)] 
 
 
        IRS Form 8233: 
        EXEMPTION FROM WITHHOLDING OF COMPENSATION FOR PERSONAL SERVICES 
 
        IRS Form  8233 is  an alternative  to a  CERTIFICATE OF EXEMPTION 
        FROM WITHHOLDING  IN LIEU  OF W-4.  The following is the abstract 
        describing Form 8233 in the IRS Printed Product Catalog: 
 
 
             8233                      62292K                      (Each) 
 
             Exemption from  Withholding  of  Compensation  for  Personal 
             Services 
 
             Used by  non resident  alien individuals  to claim exemption 
             from  withholding  on  compensation  for  personal  services 
             because of  an income  tax treaty  or the personal exemption 
             amount.  D:R:FP:F  Tax Related Public Use 
 
                                            [IRS Printed Product Catalog] 
                                        [Document 7130, Rev. 6-89, p. 66]