Employee Withholding Form W-4 - Fargo Care Solutions LLC

Employee’s Withholding Certificate W-4

All fields marked with * are required and must be filled.

Form W-4 (2026)

Department of the Treasury – Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

Give Form W-4 to your employer. Your withholding is subject to review by the IRS.

Step 1: Enter Personal Information

(a) First name and middle initial(Required)

Last Name

(b) Social security number

Address

City or town, state, and ZIP code

Does your name match the name on your Social Security card?

If not, to ensure you receive proper credit for your earnings, contact the Social Security Administration (SSA) at 800-772-1213 or visit www.ssa.gov.

(c)

Single or Married filing separately

Married filing jointly or Qualifying surviving spouse

Head of household Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual

TIP:

Consider using the estimator at www.irs.gov/W4App to determine the most accurate withholding for the rest of the year if:

1) You are completing this form after the beginning of the year.

2) You expect to work only part of the year.

3) You have changes during the year in your marital status.

4) You have multiple jobs (you and/or your spouse, if married filing jointly).

5) You have dependents.

6) You have other income (not from jobs).

7) You have deductions or credits.

Have your most recent pay stubs from this year available when using the estimator.

At the beginning of next year, use the estimator again to recheck your withholding.

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.

See page 2 for more information on each step, who can claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App.

Step 2: Multiple Jobs or Spouse Works

Complete this step if:

1) You hold more than one job at a time, OR

2) You are married filing jointly and your spouse also works.

The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following:

(a) Reserved for future use.

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below.

This option is generally more accurate than (b) if pay at the lower-paying job is more than half of the pay at the higher-paying job.

Untitled

Higher Paying job. otherwise (b) is more accurate ...............

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs.

Leave those steps blank for the other jobs.

Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest-paying job.

Step 3: Claim Dependent and Other Credits

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,200

Multiply the number of other dependents by $500 .....

Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here

Step 4 (optional): Other Adjustments

(a) Other Income (Not from Jobs)

If you want tax withheld for other income you expect this year that will not have withholding, enter the amount of that income here.

This may include interest, dividends, and retirement income.

4(a)

(b) Deductions

If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3.

Enter the calculated amount in the appropriate section of this form.

4(b)

(c) Extra Withholding

Enter any additional tax you want withheld from each pay period.

4(c)

Step 5: Sign Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s Signature:

(This form is not valid unless you sign it.)

Signature(Required)

Date