Kansas Employees Withholding Allowance Certificate

Employees Withholding Allowance Certificate
K-4 Employees Withholding Allowance Certificate Rev. 11-18_ADA_fillable
500518

KANSAS

K-4

EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE

(Rev. 11-18)

Use the following instructions to accurately
complete your K-4 form, then detach the
lower portion and give it to your employer.
For assistance, call the Kansas Department
of Revenue at 785-368-8222.

because you had no tax liability; and 2)
this year you will receive a full refund of all
STATE income tax withheld because you
will have no tax liability.

Purpose of the K-4 form: A completed

exempt, complete the Personal Allowance
Worksheet that follows. The total on line F
should not exceed the total exemptions you
claim under “Exemptions and Dependents”
on your Kansas income tax return.
NOTE: Your status of “Single” or “Joint” may
differ from your status claimed on your federal
Form W-4).
Using the information from your Personal
Allowance Worksheet, complete the K-4
form below, sign it and provide it to your
employer. If your employer does not receive

withholding allowance certificate will let your
employer know how much Kansas income tax
should be withheld from your pay on income
you earn from Kansas sources. Because
your tax situation may change, you may want
to re-figure your withholding each year.

Exemption from Kansas withholding:

To qualify for exempt status you must verify
with the Kansas Department of Revenue
that: 1) last year you had the right to a
refund of all STATE income tax withheld

Basic Instructions: If you are not

a K-4 form from you, they must withhold
Kansas income tax from your wages without
exemption at the “Single” allowance rate.
Head of household: Generally, you may
claim head of household filing status on
your tax return only if you are unmarried
and pay more than 50% of the cost of
keeping up a home for yourself and for
your dependent(s).
Non-wage income: If you have a large
amount of non-wage Kansas source income,
such as interest or dividends, consider
making Kansas estimated tax payments on
Form K-40ES. Without these payments, you
may owe additional Kansas tax when you
file your state income tax return.

Personal Allowance Worksheet (Keep for your records)
A Allowance Rate: If you are a single filer mark “Single”
If you are married and your spouse has income mark “Single”
If you are married and your spouse does not work mark “Joint”

A

o Single
o Joint

B Enter “0” or “1” if you are married or single and no one else can claim you as a dependent (entering “0” may help
you avoid having too little tax withheld) ......................................................................................................................... B

_________

C Enter “0” or “1” if you are married and only have one job, and your spouse does not work (entering “0” may help
you avoid having too little tax withheld) ......................................................................................................................... C

_________

D Enter “2” if you will file head of household on your tax return (see conditions under Head of household above) ......... D

_________

E Enter the number of dependents you will claim on your tax return. Do not claim yourself or your spouse or
dependents that your spouse has already claimed on their form K-4 ........................................................................... E

_________

F Add lines B through E and enter the total here ........................................................................................................... F

_________

 Cut here and give the lower portion to your employer. Keep the top portion for your records. 

Kansas Employee’s Withholding Allowance Certificate

Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the
Kansas Department of Revenue. Your employer may be required to send a copy of this form to the Department of Revenue.
1

Print your First Name and Middle Initial
Mailing address

2 Social Security Number

Last Name
3 Allowance Rate

Mark the allowance rate selected in Line A above.

o

o

Single

4

Total number of allowances you are claiming (from Line F above) ...............................................................................

4

5

Enter any additional amount you want withheld from each paycheck (this is optional).................................................

5

Joint

$

6

I claim exemption from withholding. (You must meet the conditions explained in the “Exemption from withholding”
instructions above.) If you meet the conditions above, write “Exempt” on this line .......................................................
6
Note: The Kansas Department of Revenue will receive your federal W-2 forms for all years claimed Exempt.
Under penalties of perjury, I declare that I have examined this certificate and to the best of my knowledge and belief it is true, correct, and complete.
SIGN
Date
HERE
7

Employer’s Name and Address

8 EIN (Employer ID Number)