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 this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct
If you check Item number 4, enter one of these:
If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3.
Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee’s first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions.
List A
List B
List C
Certification: I attest, under penalty of perjury, that(1) i have examined the documentation presented by the above-named employee,(2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to the best of my knowledge, the is authorized to work in the United States.
Employer's Business or Organization Name
Distinct Engineering Solutions, Inc.
Employer's Business or Organization Address, City or Town, State, ZIP Code
425 Old Georges Road, North Brunswick NJ 08902
For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.
State of New Jersey – Division of Taxation
Employee’s Withholding Allowance Certificate
BASIC INSTRUCTIONS
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Line 1: Enter your name, address, and Social Security number in the spaces provided.
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Line 2: Check the box that indicates your filing status. If you checked Box 1 (Single) or Box 3 (Married/Civil Union Partner Separate), you will be withheld at Rate A.
Note: If you checked Box 2 (Married/Civil Union Couple Joint), Box 4 (Head of Household), or Box 5 (Qualifying Widow(er)/Surviving Civil Union Partner), and either your spouse/civil union partner works or you have more than one job or source of income and the combined total of all wages is greater than $50,000, see Instruction A below. If you do not complete Line 3, you will be withheld at Rate B.
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Line 3: If you have chosen to use the wage chart below, enter the appropriate letter.
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Line 4: Enter the number of allowances you are claiming. Entering a number here will decrease the amount of withholding and could result in an underpayment on your return.
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Line 5: Enter the amount of additional withholdings you want deducted from each pay.
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Line 6: Enter “EXEMPT” if you are exempt from New Jersey Gross Income Tax Withholdings and meet one of the following:
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Your filing status is SINGLE or MARRIED/CIVIL UNION PARTNER SEPARATE and your total income will be $10,000 or less for the year.
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Your filing status is MARRIED/CIVIL UNION COUPLE JOINT, and combined income will be $20,000 or less for the year.
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Your status is HEAD OF HOUSEHOLD or QUALIFYING WIDOW(ER)/SURVIVING CIVIL UNION PARTNER and your total income will be $20,000 or less.
Note: Your exemption is valid for ONE year only. You must submit a new form each year to remain exempt. For help, call the NJ Division of Taxation Customer Service Center at (609) 292-6400.
Instruction A - Wage Chart
This chart is designed to increase withholdings if your wages will be taxed at a higher rate due to additional income reported on your NJ-1040 return. It does not apply to other income; use Line 5 for that. This chart is for taxpayers who are:
Single individuals or those filing separate returns do not need to use this chart. If your status is #2, 4, or 5 on the NJ-W4 and your income is above $50,000, you should consider using the wage chart. (See Rate Tables on the reverse side.)