Louisiana Employee Withholding Exemption Certificate (L-4)

Louisiana Employee Withholding Exemption Certificate (L-4)

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
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Louisiana Employee Withholding Exemption Certificate (L-4)

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Instructions
Louisiana Earned Income Credit (EIC)
Block A- Personal Exemptions
- Enter “0” to claim neither yourself nor your spouse, and check “No exemptions or dependents claimed”.You may enter “0” if you are married, and have a working spouse or more than one job to avoid having too little tax withheld.
- Enter “1” to claim yourself, and check “Single” if you did not claim this exemption in connection with other employment, or if your spouse has not claimed your exemption. Enter “1” to claim one personal exemption if you will file as head of household, and check “Single”.
- Enter “2” to claim yourself and your spouse, and check “Married”.
OLD -Block A- Select an exemption*
Block A - Select an exemption *
Block A exemption (Read only)

No Exemptions or dependents claimedSingleMarried
OLD- Select A*

No exemptions or dependents claimed
OLD- Select B*

Single
OLD- Select C*

Married
Employee Information & Elections
Employee Legal Name*

Legal First NameLegal Middle initialLegal Last Name
Employee Email*
example@example.com
Employee Social Security Number*
Employee Address*

Street Address

Apartment or Unit Number

CityState

Zip Code
6. Block A Total number of exemptions claimed (Read only)
7. Block B Total number of dependents claimed (Read only)
Signatures

I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/
I declare under the penalties imposed for filing false reports that the number of exemptions and dependency credits claimed on this certificate do not exceed the number to which I am entitled.
Employee signature*

Clear
Date of Signature*

MonthDayYear
Date
I have clicked "Preview PDF" and reviewed my form for accuracy*

YesNo
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Louisiana Employee Withholding Exemption Certificate (L-4)

Louisiana Employee Withholding Exemption Certificate (L-4)

Block A- Personal Exemptions

Employee Information & Elections

Signatures