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This form can be used to manually compute your
withholding allowances, or you can electronically
compute them at www.taxes.ca.gov/de4.pdf.

EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE


Type or Print Your Full Name Your Social Security Number

Home Address (Number and Street or Rural Route) Filing Status Withholding Allowances
† SINGLE or MARRIED (with two or more incomes)
City, State, and ZIP Code †MARRIED (one income)
†HEAD OF HOUSEHOLD

1. Number of allowances for Regular Withholding Allowances, Worksheet A


Number of allowances from the Estimated Deductions, Worksheet B
Total Number of Allowances (A + B) when using the California
Withholding Schedules for 2016
OR
2. Additional amount of state income tax to be withheld each pay period (if employer agrees), Worksheet C
OR
3. I certify under penalty of perjury that I am not subject to California withholding. I meet the conditions set forth under
the Service Member Civil Relief Act, as amended by the Military Spouses Residency Relief Act. (Check box here) †
Under the penalties of perjury, I certify that the number of withholding allowances claimed on this certificate does not exceed the
number to which I am entitled or, if claiming exemption from withholding, that I am entitled to claim the exempt status.

Signature Date

Employer’s Name and Address California Employer Account Number

cut here

Give the top portion of this page to your employer and keep the remainder for your records.

YOUR CALIFORNIA PERSONAL INCOME TAX MAY BE UNDERWITHHELD IF YOU DO NOT FILE THIS DE 4 FORM.

IF YOU RELY ON THE FEDERAL FORM W-4 FOR YOUR CALIFORNIA WITHHOLDING ALLOWANCES, YOUR CALIFORNIA STATE
PERSONAL INCOME TAX MAY BE UNDERWITHHELD AND YOU MAY OWE MONEY AT THE END OF THE YEAR.

PURPOSE: This certificate, DE 4, is for California Personal Income certificate for your state income tax withholding, you may
Tax (PIT) withholding purposes only. The DE 4 is used to compute be significantly underwithheld. This is particularly true if your
the amount of taxes to be withheld from your wages, by your household income is derived from more than one source.
employer, to accurately reflect your state tax withholding obligation.
CHECK YOUR WITHHOLDING: After your Form W-4
You should complete this form if either: and/or DE 4 takes effect, compare the state income tax withheld
with your estimated total annual tax. For state withholding, use
(1) You claim a different marital status, number of regular allowances, the worksheets on this form.
or different additional dollar amount to be withheld for California PIT
withholding than you claim for federal income tax withholding or, EXEMPTION FROM WITHHOLDING: If you wish to claim
exempt, complete the federal Form W-4. You may claim exempt
(2) You claim additional allowances for estimated deductions. from withholding California income tax if you did not owe
THIS FORM WILL NOT CHANGE YOUR FEDERAL any federal income tax last year and you do not expect to owe
WITHHOLDING ALLOWANCES. any federal income tax this year. The exemption is good for
one year. If you continue to qualify for the exempt filing status,
The federal Form W-4 is applicable for California withholding a new Form W-4 designating EXEMPT must be submitted by
purposes if you wish to claim the same marital status, number February 15 each year to continue your exemption. If you are not
of regular allowances, and/or the same additional dollar amount having federal income tax withheld this year but expect to have
to be withheld for state and federal purposes. However, federal a tax liability next year, you are required to give your employer a
tax brackets and withholding methods do not reflect state PIT new Form W-4 by December 1.
withholding tables. If you rely on the number of withholding
allowances you claim on your Form W-4 withholding allowance

DE 4 Rev. 44 (1-16) (INTERNET) Page 1 of 4 CU


Direct Deposit Getting Started Guide Page 5 of 6

Authorization for Direct Deposits - Employee Form


This authorizes _______________________________________________ (the "Company") to send credit
entries (and appropriate debit and adjustment entries), electronically or by any other commercially
accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify in the
future (the "Account"). This authorizes the financial institution holding the Account to post all such
entries.

NOTE: Enter your company name in the blank space above.

Account #1

Deposit (amount or %) _____________________________________________


ACCOUNT TYPE (e.g. Checking or
Savings) _____________________________________________
EMPLOYEE BANK NAME _____________________________________________
BRANCH _____________________________________________
CITY, STATE _____________________________________________
ACCOUNT NUMBER _____________________________________________
BANK ROUTING NUMBER (ABA#) _____________________________________________

Account #2

Deposit (amount or %) _____________________________________________


ACCOUNT TYPE (e.g. Checking or
Savings) _____________________________________________
EMPLOYEE BANK NAME _____________________________________________
BRANCH _____________________________________________
CITY, STATE _____________________________________________
ACCOUNT NUMBER _____________________________________________
BANK ROUTING NUMBER (ABA#) _____________________________________________

This authorization will be in effect until the Company receives a written termination notice from myself
and has a reasonable opportunity to act on it.

________________________________________________________________
SIGNATURE
________________________________________________________________
PRINTED NAME
_______________________________________________
EMPLOYEE ID #
_______________________________________________
DATE

IMPORTANT: Enter the employee's bank account and routing numbers into QuickBooks. To do this, click
the Direct Deposit button on the Payroll and Compensation Info tab for each employee. This document
must be signed by employees requesting automatic deposit of paychecks, and retained on file by the

https://pws.quickbooks.com/sub/html/ddGettingStartedGuideQB06.html 9/2/2008
Employment Eligibility Verification USCIS
Department of Homeland Security Form I-9
OMB No. 1615-0047
U.S. Citizenship and Immigration Services Expires 08/31/2019

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which
document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ
an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)

Address (Street Number and Name) Apt. Number City or Town State ZIP Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's E-mail Address Employee's Telephone Number
- -

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):


Some aliens may write "N/A" in the expiration date field. (See instructions)
QR Code - Section 1
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: Do Not Write In This Space
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:


OR
2. Form I-94 Admission Number:
OR
3. Foreign Passport Number:

Country of Issuance:

Signature of Employee Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):


I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State ZIP Code

Employer Completes Next Page

Form I-9 11/14/2016 N Page 1 of 3


Employment Eligibility Verification USCIS
Department of Homeland Security Form I-9
OMB No. 1615-0047
U.S. Citizenship and Immigration Services Expires 08/31/2019

Section 2. Employer or Authorized Representative Review and Verification


(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists
of Acceptable Documents.")
Last Name (Family Name) First Name (Given Name) M.I. Citizenship/Immigration Status
Employee Info from Section 1

List A OR List B AND List C


Identity and Employment Authorization Identity Employment Authorization
Document Title Document Title Document Title

Issuing Authority Issuing Authority Issuing Authority

Document Number Document Number Document Number

Expiration Date (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy)

Document Title

QR Code - Sections 2 & 3


Issuing Authority Additional Information Do Not Write In This Space

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,
(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)
Signature of Employer or Authorized Representative Today's Date(mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name

Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable) B. Date of Rehire (if applicable)
Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes
continuing employment authorization in the space provided below.
Document Title Document Number Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative

Form I-9 11/14/2016 N Page 2 of 3


LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.

LIST A LIST B LIST C


Documents that Establish Documents that Establish Documents that Establish
Both Identity and Identity Employment Authorization
Employment Authorization OR AND

1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a 1. A Social Security Account Number
State or outlying possession of the card, unless the card includes one of
2. Permanent Resident Card or Alien
United States provided it contains a the following restrictions:
Registration Receipt Card (Form I-551)
photograph or information such as (1) NOT VALID FOR EMPLOYMENT
name, date of birth, gender, height, eye
3. Foreign passport that contains a color, and address (2) VALID FOR WORK ONLY WITH
temporary I-551 stamp or temporary INS AUTHORIZATION
I-551 printed notation on a machine- 2. ID card issued by federal, state or local (3) VALID FOR WORK ONLY WITH
readable immigrant visa government agencies or entities, DHS AUTHORIZATION
provided it contains a photograph or
4. Employment Authorization Document information such as name, date of birth, 2. Certification of Birth Abroad issued
that contains a photograph (Form gender, height, eye color, and address by the Department of State (Form
I-766) FS-545)
3. School ID card with a photograph
5. For a nonimmigrant alien authorized 3. Certification of Report of Birth
to work for a specific employer 4. Voter's registration card issued by the Department of State
because of his or her status: (Form DS-1350)
5. U.S. Military card or draft record
a. Foreign passport; and 4. Original or certified copy of birth
6. Military dependent's ID card certificate issued by a State,
b. Form I-94 or Form I-94A that has
county, municipal authority, or
the following: 7. U.S. Coast Guard Merchant Mariner territory of the United States
(1) The same name as the passport; Card bearing an official seal
and
8. Native American tribal document 5. Native American tribal document
(2) An endorsement of the alien's
nonimmigrant status as long as 9. Driver's license issued by a Canadian
6. U.S. Citizen ID Card (Form I-197)
that period of endorsement has government authority
not yet expired and the 7. Identification Card for Use of
proposed employment is not in For persons under age 18 who are Resident Citizen in the United
conflict with any restrictions or unable to present a document States (Form I-179)
limitations identified on the form. listed above:
8. Employment authorization
6. Passport from the Federated States of document issued by the
10. School record or report card
Micronesia (FSM) or the Republic of Department of Homeland Security
the Marshall Islands (RMI) with Form 11. Clinic, doctor, or hospital record
I-94 or Form I-94A indicating
nonimmigrant admission under the 12. Day-care or nursery school record
Compact of Free Association Between
the United States and the FSM or RMI

Examples of many of these documents appear in Part 8 of the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Form I-9 11/14/2016 N Page 3 of 3

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