Virginia Employee's Withholding Income Tax Credit for Income Taxes Paid to Another State

Employee's Withholding Income Tax Credit for Income Taxes Paid to Another State
VA-4B 06 01 05.indd
FORM VA‑4B

VIRGINIA EMPLOYEE’S CREDIT FOR INCOME
TAXES PAID TO ANOTHER STATE
INSTRUCTIONS

EMPLOYEE:
If you are eligible for an out-of-state tax credit on your Virginia individual income tax return under the
provisions of Section 58.1-332, Code of Virginia, complete this form to authorize your employer to
allow a portion of the credit each pay period to reduce the Virginia income taxes withheld from your
wages. The definitions for “resident” and “nonresident” in Section A and the directions for computing
the credit for taxes paid to another state are in the instructions for completing the Virginia resident and
nonresident individual income tax returns.
EMPLOYER:
On receipt of this form, properly executed by the employee, complete Section B. This form authorizes
you to reduce the amount of Virginia withholding taxes normally withheld by the amount in Section B.
If the employee becomes ineligible for this withholding out-of-state tax credit, resume the full amount
of withholding beginning with the first payroll period ending after you receive a notice of change of
status or otherwise become aware of the employee’s change of status.

FORM VA‑4B - VIRGINIA EMPLOYEE’S CREDIT FOR INCOME TAXES PAID TO ANOTHER STATE
SECTION A TO BE COMPLETED BY EMPLOYEE
Your social security number					

Name

Street Address
City								

State			

ZIP Code

1. Year for which Virginia individual income tax return will be filed.................................................... 	 _ _________________
2. Virginia return type (check one)............................................ j Form 760........... j Form 760PY........j Form 763
3. Amount of Virginia income tax credit for income taxes paid to another state (or district)................	 _ ___________ .	 _____
	
4. Name of the other state (or district)................................................................................................ 	 _ _________________
SIGNED ________________________________________________________________________ DATE ____________
SECTION B TO BE COMPLETED BY EMPLOYER
1. Estimated tax credit for the year per employee’s statement in Section A........................................	 _ ___________ .	 _____
2. Number of pay periods remaining in the year................................................................................ 	 _ _________________
3. Divide Line 1 by Line 2....................................................................................................................	 _ ___________ . _____
REDUCE THE VIRGINIA INDIVIDUAL INCOME WITHHOLDING TAX PER PAY PERIOD BY THE AMOUNT ON LINE 3.
KEEP THIS FORM WITH THE EMPLOYEE’S FORM VA-4.					
(Rev 5/05) 2601200