Affidavit of Exemption from Withholding in Lieu of W-4

AFFIDAVIT OF EXEMPTION FROM WITHHOLDING IN LIEU OF W-4

Consistent and in pari materia with Section 3402(n) of the Internal Revenue Code ("IRC"), shown herewith, I hereby certify to being EXEMPT by law from all federal income tax withholdings because:

A. No liability for income tax has knowingly been incurred by Me under Subtitle A in the past year or in previous years.

B. No liability for income tax will knowingly be incurred by Me under Subtitle A in the current year or in future years.

Effective immediately, stop all federal tax withholdings.

The only statutes which impose a specific liability for federal income taxes imposed by Subtitle A are those which are found in the provisions applicable to withholding agents, as itemized in the definition of "Withholding agent" at IRC 7701(a)(16).

Thank you for your consideration.

VERIFICATION

The Undersigned hereby verifies, under penalty of perjury, under the laws of the United States of America, without the "United States" (federal government), that the above statement is true and correct, to the best of My current information, knowledge, and belief, so help Me God, pursuant to 28 U.S.C. 1746(1).

Executed on: ______

Month / Day / Year

Signed: ______

(blue ink signature)

Name: ______

(printed name)

Address: ______

(c/o street, post office box, or general delivery)

County: ______

(name of county, followed by "county")

UnionState: ______

(one of the 50 states of the Union)

Attachments:

Internal Revenue Code, Section 3402(n):

(n) Employees Incurring No Income Tax Liability. --

Notwithstanding any other provision of this section, an

employer shall not be required to deduct and withhold any

tax under this chapter upon a payment of wages to an

employee if there is in effect with respect to such payment

a withholding exemption certificate (in such form and

containing such other information as the Secretary may

prescribe) furnished to the employer by the employee

certifying that the employee --

(1) incurred no liability for income tax imposed under

Subtitle A for his preceding taxable year, and

(2) anticipates that he will incur no liability for income

tax imposed under Subtitle A for his current taxable

year.

The Secretary shall by regulations provide for the

coordination of the provisions of this subsection with the

provisions of subsection (f).

[IRC 3402(n)]

IRS Form 8233:

EXEMPTION FROM WITHHOLDING OF COMPENSATION FOR PERSONAL SERVICES

IRS Form 8233 is an alternative to a CERTIFICATE OF EXEMPTION

FROM WITHHOLDING IN LIEU OF W-4. The following is the abstract

describing Form 8233 in the IRS Printed Product Catalog:

8233 62292K (Each)

Exemption from Withholding of Compensation for Personal

Services

Used by non resident alien individuals to claim exemption

from withholding on compensation for personal services

because of an income tax treaty or the personal exemption

amount. D:R:FP:F Tax Related Public Use

[IRS Printed Product Catalog]

[Document 7130, Rev. 6-89, p. 66]