California State Tax Withholding Election Form

California State Tax Withholding Election Form
Complete this form to indicate your California state tax withholding election. Please provide accurate information to ensure proper processing.
Full Name
First NameLast Name
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employee ID (if applicable)
Employer Name
Employment Status
Withholding Status
Number of Allowances Claimed
Additional Amount to Withhold (per pay period, if any)
Comments or Special Instructions
Should be Empty: