Appendix X


Certificate of Exemption from Withholding


Reader's Notes:




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

andWithout Prejudice to Any of My Unalienable Rights



Signed: _________________________________________________________


Name: ___________________________________________________________


Address: ________________________________________________________


County of: ______________________________________________________


State of: _______________________________________________________



California All-Purpose Acknowledgement




††††††††††††††††††††††††††††††† )

COUNTY OF MARIN†††††††††††††††† )



††††† On the ________ day of ____________, 200__ 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:



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:FTax Related Public Use


[IRS Printed Product Catalog]

[Document 7130, Rev. 6-89, p. 66]






Readerís Notes: