Withholding Certificate for Monthly Pension or Annuity ...
Withholding Certificate for Monthly Pension
or Annuity Payments
Retirement Systems of Alabama PO Box 302150, Montgomery, Alabama 36130-2150 877.517.0020 ? 334.517.7000 ? rsa-
Your Information
Your SSN
Check One: q TRS q ERS q JRF q MRS q SNU
Name___________________________________________________________________________________________
First
Middle/Maiden
Last
Mailing Address____________________________________________________________________________________
Street or P.O. Box
Apt.#
City
State
ZIP Code
Telephone Number____________________________ Email Address__________________________________________
Date of Birth ________________________________ PID (optional) ______________________________________________
Check One: q Retiree q Beneficiary of Deceased Retiree or Member If you are a beneficiary, please provide the following for the deceased retiree or member. Name ___________________________________________ SSN ______________________________
Withholding Information
If you do not complete this information, we are
required to withhold as if you are a married individual claiming three
exemptions.
Choose one of the withholding options below:
1. q I do not want to have federal withholding tax deducted from my monthly pension or annuity. I realize that I am liable for payment of federal income tax on the taxable portion of my pension or annuity and that I may be subject to tax penalties under the estimated tax payment rules if my payment(s) of estimated tax and withholding are not adequate. (Sign the form and return to the RSA. Do not complete any other areas of this form.)
2. q I want to have federal withholding tax calculated using my marital status and the number of exemptions claimed. You must complete both lines A and B.
Personal income tax questions should be directed to your tax advisor, accountant, or Internal Revenue Service
Center.
A. Marital Status q Single q Married q Married, but withhold at a higher Single rate
B. Total Exemptions Claimed: ___________________ (if blank, the RSA will assume zero (0))
3. q I want the following additional amount withheld from each pension or annuity payment. For periodic payments, you can not enter an amount here without entering the Marital Status on line A, and the number, including zero (0), of an allowance on line B.
$___________________
A. Marital Status q Single q Married q Married, but withhold at a higher Single rate B. Total Exemptions Claimed: ___________________ (if blank, the RSA will assume zero (0))
Signature Certification
Sign Here ? Your Signature ______________________________________________________ Date _________________________
RSA_WCPAP
REV 03-2022
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