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]
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