- Paper: Letter (8.5in x 11in)
- Copies to print: 2
- Give a blank form to a new employee or to employees who have changes in their tax situation.
- The employee fills up this form and returns it to the employer.
- Employers must keep a copy for their records.
- Send a signed copy of this form if an employer believes an employee improperly claimed too many exemptions or dependency credits.
- The employer must include an explanation as to why they believe that the employee improperly completed this form and any other supporting documentation and mail to:
Louisiana Department of Revenue
Criminal Investigations Division
PO Box 2389
Baton Rouge LA 70821-2389
- Login: https://esweb.revenue.louisiana.gov/LaWage/Login.aspx
- Register: https://esweb.revenue.louisiana.gov/LaWage/Register.aspx
- If the number of an employee's claimed allowances decreases, they must file a new form within 10 days after the change. Except if the change is the result of the death of a spouse or a dependent.
- You may file a new form any time your withholding allowances increases.
- For newly hired employees to report their withholding exemption to their employer. It is also for employees who have recently changed their tax status which will affect their withholding exemptions.
- Louisiana Dept. of Revenue
- (855) 307-3893