NTERNAL REVENUE SERVICE (IRS) is sending this 

mer service and outreach efforts to reduce taxpayer burden.

ou decide whether to stop the withholding on your income.

ng will prevent you from filing unnecessary returns, and you

oughout the year.

4 and claiming an exemption for 2005, you can access the IRS

 to www.irs.gov, select the Forms and Publications option, 

e information on Form W-4. You can reach us by phone at 

rs of operation are Monday through Friday from 7:00 a.m. 

ng January 22 - April 9, 2005, assistance will be available on

 p.m. local time. Assistance provided to callers from Alaska

rs of operation in the Pacific Time Zone. We continue to offer

nd and account callers.

enue Service
PRSRT STD

POSTAGE & FEES PAID

INTERNAL REVENUE SERVICE

PERMIT NO. G-48
ars Old

quired To Have Federal Tax Withheld

Department of the TreasuryInternal Revenue Service

www.irs.gov

Publication 3136 (Rev. 1-2005)Catalog Number 26212U

IRS
uFor 2004 and 2005, will your total interest and 

dividends be $250 or less each year, or will your total income be $750 or less each year?  Y  N

i Will your total income for 2004 and 2005 

be $4,850 or less each year? Y  N

If both 4 and 5 are “Yes,” see Claiming an Exemption.Otherwise, you should not use this mailing to claim anexemption from Federal income tax withholding; please discard it.

oFor 2004 and 2005, will your total interest, dividends,

and wages be $7,950 or less each year? Y  N

If 6 is “Yes”, see Claiming an Exemption. Otherwise, you

should not use this mailing to claim an exemption from Federal income tax withholding; please discard it.

le a Federal income tax return in the year 2005?
s o

then

Your employer can stop deducting Federal

taxes for all of the 2005 tax year

Send a Form W-4 to your employer 

by early December 2004

You probably will not have to file 

a tax return in the year 2006
. Give to your employer.

of these time estimates or suggestions for making this form simpler, we would be happy to hearform you. You can write to the Tax Forms Committee, Western Area Distribution Center, RanchoCordova, CA 95743-0001. DO NOT send the tax form to this address. Instead, give it to your employer.You are not required to provide the information requested on a form that is subject to the PaperworkReduction Act unless the form displays a valid OMB control number. Book or records relating to aform or its instructions must be retained as long as their contents may become material in theadministration of any Internal Revenue law. Generally, tax returns and return information areconfidential, as required by Code section 6103.

U.S. Government Printing Office: 2002-474-514

OMB No. 1545-0010

ding Allowance Certificate

number of allowances or exemption from withholding is

may be required to send a copy of this form to the IRS.

2 Your social security number

3 Single Married Married, but withhold at higher Single rate.

Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

ve or from the applicable worksheet on page 2) 5

heck 6 $

t I meet both of the following conditions for exemption.

x withheld because I had no tax liability and

eld because I expect to have no tax liability.

7

he best of my knowledge and belief, it is true, correct, and complete.

Date



 sending to the IRS.) Office code 9 Employer identification number (EIN)

(optional)

10

4 If your last name differs from that shown on your social security

card, check here. You must call 1-800-772-1213 for a new card.



Cat. No. 10220Q Form W-4 (2005)

2005