Employee's Withholding Allowance Certificate (California)

First, Middle, Last Name Social Security Number Address City State ZIP Code Single or Married (with two or more incomes) Married (one income) Head of Household 1a. Number of Regular Withholding Allowances (Worksheet A) 1b. Number of allowances from Estimated Deductions (Worksheet B) 1c. Total Number of Allowances you are claiming 2. Additional amount withheld each pay period (Worksheet C) 3. Exemption from Withholding (Check box here) 4. Military Spouse exemption (Check box here) Date