FOIA
EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATION - MILLS, MONTRELL EUGENE
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001308880
Release Decision:
RIPPUB
Original Classification:
U
Document Page Count:
1
Document Release Date:
February 19, 2008
Sequence Number:
Case Number:
F-2005-00558
Publication Date:
April 13, 1964
File:
| Attachment | Size |
|---|---|
 DOC_0001308880.pdf | 53.61 KB |
Body:
(b) (3) (b) (6) n w-4 (Rev. July 1952) 3. Treeeury Deportment tercel (,avenue Service F I----- Print home address 2623 4. Newton Circle, Irvin, Texas EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE Montrell Eu one Mills social Security xo. Print full name -- ------------------------------------------------------------------ EMPLOYEE;,,,_,, File this form with your employer.. 0th- erwise hemustwW. hold U1 I,"-h onie tax from your wages wM utexelPUon: EMPLOYER:,;, , Keep this certiil? ate with your ree. ords. If the employee Is believed to have claimed too many ex- emptiens, the Direc- tor should beso advised. 1 I. SINGLE, and you'clafman exemptidn;'write the figure "I' . 3 b it you? claim one of these exemptions; "te the figure "1" c If you claim neither of these exemptions, write exemption for a dependent unless you are qualltted under instruction a on other ode l _ /,[iyi~ t 4. Exemptions for age and blindness (applicabll,$njyou:and your 'wife but not 'to*dependents , ml.: (a) If you or your wife will be 65 years of age or older at the end-of the year, and you claim this exemption, write the write the figure "l"; if both will be 65 or older and you claim both,of these exemptions , figure "2.. (b) If you or your wife are blind, and you claim this exemption, write the figure "I", if both are blind, and you claim both of these exemptions, write the figure "2"a ... . 5. Add the number of exemptions which you, have claimed"above and write the total.:..... I CERTIFY that the number of withholding exemptions claimed on this certific 11 (Date) _13-April -----------------i9-64 APPROVED FOR RELEASE DATE: NOV 2007
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