2020 Georgia Tax

Withholding

Atlanta Office

This online form is only for applicants/employees who do not have complex tax allowance set up. For anyone who needs to calculate additional deductions and allowances, please ask the office staff to email you the complete tax worksheet. Print that out, complete it and email, fax or mail it back to the Prosper Home Care Office.

If you use standard deduction allowances, you may complete this online form.

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Social Security Number *

Are you a new hire or an existing employee? *

New Hire

Existing Employee

Filing Status

Marital Status *

A - Single	B - Married Filing Joint, both spouses working
C - Married Filing Joint, one spouse working	D - Married Filing Separate
E - Head of Household

Enter 0 or 1 to claim an allowance (A) *

0

1

Enter 0 or 1 to claim an allowance (B) *

0

1

Enter 0 or 1 or 2 to claim an allowance (C) *

0

1

2

Enter 0 or 1 to claim an allowance (D) *

0

1

Enter 0 or 1 to claim an allowance (E) *

0

1

Choose the number of dependent allowances you wish to claim. *

Do you wish to have additional funds deducted from your paycheck for Georgia taxes? *

Yes

No

If yes, enter that amount here. *

Do you wish to claim exemption because you incurred no Georgia income tax liability last year and you expect that you will have no Georgia income tax liability this year? *

Yes

No

By signing below, I certify under penalty of perjury that I am entitled to the number of withholding allowances or the exemption from withholding status claimed on the Form G-4. Also, I authorize my employer to deduct per pay period the additional amount listed above. *

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