EFTA00525136.pdf

The exceptions don't apply to supplemental wages Nomvago income. If you have a bre. amount of Form W-4 (2017) greater than $1,000,000. nonwage income, such as Interest ccdividends. consider making estimated tax nts using Form Saab instructions.If you aren't exempt, con te 1040-ES. Estimated Tax for widuais. Otherwise, Purpose. Complete Form W.4 so that your the Personal Allowances Worksheet below. The you may Owe additional tax. If you have pension or employer can withhold the correct federal Income worksheets on page 2 further adjust your annuity Income, see Pub. 50510 Ind out if you should tax from your pay. Consider completing a new Form withholding allowances based on itemized adjust your withholding on Form V4.4 or W-4P. W-4 each year and when your personal or financial deductions, certain credits, arkustments to income, situation changes. or two-earners/multiple jobs situations. Two earners or multiple jobs. II you have a Exemption from withholding. II you are exempt, Complete all worksheets that apply. However, you working spouse or more than one job, figure the complete only ines 1, 2, 3, 4, and 7 and sign the may claim fewer (or zero) allowances. For tegutar total number of allowances you are entitled to claim form to validate it. Your exemption for 2017 expkes wages, withholding must bo based on allowances on el jobs using worksheets from only one Form February 15, 2018. See Pub. 505. Tax Withholding you clamed and may not be a fiat amount or W-4. Your withholding ustiVy cos be most accurate and Estimated Tax. percentage of wages. when all allowances are ctirned on the Form W-4 for the highest paying pb and zero allowances are Note: if another person can claim you as a dependent Head of household. Generally', you can claim head claimed on the others. Soo Pub. 505 for derails. on his or her tax return, you can't claim exemption of household filing status on your tax return only if Nonresident alien. If you a:e a norrosidonl alien. see from withholding if your total income exceeds $1,050 you are unmarried and pay more than 50% of the Notice 1392, Supplemental Fcim W-4 Instructions for and includes more than $350 of unearned income (for Costs of keeping up a home for yourself and your Nonresident Aliens, before completing lHa form. example, interest and dividends). depending') or other qualifying individuals. See Exceptions. An employee may be able to claim Pub. 501, Exemptions, Standard Deduction, and Check your withholding. After your Form W-4 takes exemption from withholding oven if the employee is F8ng Information, for information. effect, use Pub. 505 to see how the amount you are a dependent, if the employee: Tax credits. You can take projected tax credits into having withheld compares to your projected total tax account in figuring your allowable number of for 2017. See Pub. 505. especially!flour earnings • Is ago 65 or older, withholding allowance. Credits for chid or dependent exceed $130,000 (Single) or $180,000 (Manisa • Is blind, or care expenses and the ct•ld tax creed may be claimed Future developments. Information about any future • Wall claim adjustments to income; tax credits; or using the Personal Allowances Worksheet below. developments affecting Form W-4 (such as See Pub. 505 for information on converting your other legislation enacted after we release it) will be posted lionized deductions, on his or her tax return. credits into withholding allowances. at wrnv.ksgovfre4. Personal Allowances Worksheet (Keep for your records.) A Enter "1" for yourself if no ono else can claim you as a dependent A • You're single and have only one Job; or - B Enter "1" if: { • You're married, have only one Job, and your spouse doesn't work; or B • Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less. / C Enter "1" for your spouse. But, you may choose to enter "-0-" if you are married and have either a working spouse or more than one job. (Entering "-0-" may help you avoid having too little tax withheld ) C D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return D E Enter "1" If you will file as head of household on your tax return (see conditions under Head of household above) . E F Enter "1" If you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . F (Note: Do not include child support payments. See Pub. 50G, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. • If your total income will be less than $70,000 ($100,000 If married), enter "2" for each eligible child; then less "1" If you have two to four eligible children or less "2" if you have five or more eligible children. • if your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter "1" for each eligible child. G H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) so H • if you plan to Itemize or claim adjustments to Income and went to reduce your withholding, see the Deductions For accuracy, and Adjustments Worksheet on page 2. complete all • if you are single and have more than one job or are married and you and your spouse both work and the combined worksheets earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 that apply. to avoid having too little tax withheld. • If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. -------------------------- Separate here and give Form W-4 to your employer. Keep the top part for your records. Employee's Withholding Allowance Certificate Form W-4 Department of the Treastry If- Whether you are entitled to claim a certain number of allowances or exemption from withholding Is I OMB No. 1545-0074 subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 20 1 7 !Memel Revenue Service 1 Your first name and middle initial Last name 2 Your social security number Home address (number and street or nerd route) 3 0 Single • Married 0 Married, but withhold at Ngher Single rate. Note: If maniac:, but legally scented, or spouse's a nowesilent alen.chKS the 'Snit' box. City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card, check here. You must call 1.800.772.1213 for a replacement card. 1:- 0 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 6 Additional amount, if any, you want withheld from each paycheck 6 $ 7 I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption. • Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and • This year I expect a refund of all federal Income tax withheld because I expect to have no tax liability if you meet both conditions, write "Exempt" here * I 7I Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee's signature (This font is not valid unless you sign it) p. Date w 8 Employees name and address (Employer: Complete fines 8 and 10 only if sending to the IRS.) 9 0lke code (optioned, 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, sea page 2. Cat. No. 102200 Form W-4 (2017) EFTA00525136  Form W-4 (2017) Page 2 Deductions and Adjustments Worksheet Note: Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. 1 Enter an estivate of you 2017 dented deductions. These include qualifying home mortgage Interest, charitable contributions, state and kcal taxes, medical expenses in excess of 10%d your Income, and miscellaneous deductions. For 2017, you may have to reduce your itemized deductions if your income is over $313,800 and you're married filing jollity or you're a quail** "*lowiht $287,650 d you're head of household; $261,500 II you're single, not head of househdd and not a qualifying widow*); or $156,900 if you're married filing separately. See Pub. 505 for dais 1 $ $12,700 if married filing jointly or qualifying widow(er) 2 Enter: i $9,350 If head of household 2 $ $6,350 if single or monied filing separately 3 Subtract line 2 from line 1. If zero or less, enter "-0-• 3 $ 4 Enter an estimate of your 2017 adjustments to income and any additional standard deduction (see Pub. 505) 4 $ 5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Conceding Credits to Withholding Allowances for 2017 Foam W-4 worksheet in Pub. 505.) 6 $ 6 Enter an estimate of your 2017 nonwage Income (such as dividends or Interest) 6 S 7 Subtract line 6 from line 5. If zero or less, enter '-O-" 7 $ 8 Divide the amount on line 7 by $4,050 and enter the result here. Drop any fraction 8 9 Enter the number from the Personal Allowances Worksheet, line H, page 1 9 10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Eamers/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10 Two-Earners/Multiple Jobs Worksheet (See Two eamers or multiple lobs on page 11 Note: Use this worksheet only if the instructions under line H on page 1 direct you here. 1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying Job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than "3" 2 3 If line 1 is more than or equal to fine 2, subtract fine 2 from line 1. Enter the result here (if zero, enter '-0--) and on Form W-4, fine 5, page 1. Do not use the rest of this worksheet 3 Note: If line 1 is less than fine 2, enter - -0-11 on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill. 4 Enter the number from line 2 of this worksheet 4 5 Enter the number from line 1 of this worksheet 5 6 Subtract line 5 from line 4 6 7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . 7 $ 8 Multiply line 7 by line 6 and enter the result here. This Is the additional annual withholding needed . . 8 $ 9 Divide line 8 by the number of pay periods remaining in 2017. For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2017. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $ Table 1 Table 2 Married FIlingJointly All Others Married Filing Jointly All Others If wages from LOWEST Enter on if wages from LOWEST Enter on If wages from HIGHEST Enter on If wages from HIGHEST Enter on PlY69 Job am— Ina 2 above paying Job am— he 2 above paying Job are— line 7 above paying Job are— Me 7 than $0 - S7,030 0 SO - Se.= 0 SO - 675,000 $610 SO - $38,000 6610 7,001 • 14,000 1 8,001 - 16,000 1 75,001 - 135,000 1,010 38,001 • 85,003 1,010 14,001 • 22,000 2 16,001 - 26,000 2 135,001 - 205,000 1,130 85,001 - 185,000 1,130 22,001 - 27,000 3 28,001 • 34,000 3 205,001 - 380,000 1,340 185.031 - 400,000 1,340 27,001 - 35,000 4 34,001 - 44,000 4 360,001 - 405,000 1,420 400.001 and over 1,600 35,001 - 44,000 5 44,001 - 70,000 5 405.001 and over 1,600 44,001 - 55,000 6 70,001 - 85,000 6 55,001 - 65.000 7 85,001 - 110,000 7 65,031 • 75,003 8 110,001 - 125,000 8 75,001 • 80.000 9 125,001 - 140,000 9 80,001 - 95.000 10 140,001 and over 10 50,001 • 115,000 11 116,001 - 130,000 12 130,001 - 140,000 13 140,001 • 150,003 14 150,001 and over 15 Pdvacy Act and Paperwork Reduction Act Notice. We ask for the inform ton on Ws form You are not required to provide the Information requested on form that Is o caw out the Internal Revenue laws of the U fled Slates. Internal Revenue Code sections subject to the Papenvork Reduction Act unless the form displays a valid 0M8 34020(2) arid 6209 and their regulations meths you to provide this 'acme on; your employer control number. Books or record; relating to a form or its instructions must be uses t to determin your federal income tax ivithhdding. Failure to pro de pronely retained as long as their contents may become material in the administration of ompteled loon wi ream in year being treated &saltine, person who claims no vahhotelng any Internal Revenue law. Generally, tax returns and return information are allowances: providing fraudulent information may subject you to penrCtes. Routine uses of confidential, as reouired by Code section 6103. his information include gMng it to the department of Justice for civil and criminal fitigaticc4 to The average lime end expenses required to complete and Po this form will vary cities, states, the tastrkt of Cando. and U.S. commonwealths and possessions Ice use n depending on individual circumstances. For estimated averages, see the admnistoing their tax laws; and to the Department of Heaith and Human Services for use n Instructions for your income tax return. the National Directory or New Hies. we may also dadose this information to other countries under a lax treaty, to fedenl and state ageri s to enforce federal nontax aferinal laws. or to If you have suggestions for making this form simpler, we would be happy to heal federal law enforcement and intelligence agencies to combat terrorism. from you. See the instructions for your income tax return. EFTA00525137  EMPLOYMENT APPLICATION Position Applying fon 0 Full-Time 0 Part-Time 0 Seasonal SMTWTFSat Hours Available and/or its affiliate , is an Equal Opportunity Employer. We color, religion, sec, national origin, age, veteran status, disability, or consider applicants for all positions without regard to race, any other legally protected status. Social Security Number 1 Are you at least IS years NAME of age O Yes O No Middle Last Pint City State • Zip Present Street Address State • Bp City Previous Street Address Phone Number Alternative Phone Number Are you a US. Citizen or an you provide verifica lion of your legal right to work in the United States 0 Yes O No Position Desired 0 runtime Date An-lable for Work Have you ever been employed by ? 0 Part Time 0 Yes C No Position: ' Dates: - List names of Mends or relatives now employed b) crier/err Its affiliate List °Was machites you on operate andude WPM and Shathand) Last other equipment you an operate • Do you have any special slats or mating related to the position sought? EDUCATION Name of Institution City Jr State Circle Last Year Completed High School 9 30 11 12 College I 2 3 4 Graduate School . ' Degree received O Yes 0 No Other Date of Discharge MILITARY SERVICE BRANCH !tank Attained Date Entered EFTA00525138  EMPLOYMENT: Include all previous jobs starting with the present or most recent. May we contact your present employer? 0 Yes O No 1.. Employer Position Held & Dude Address Than No. Supervisor . --. — Data Employed Pay Rale rfCCL: To: Shrting; Mutiny —Reason for Laving a. Employer Position Held Se Dudes Address Phone No. Supenisor Dales Employed - Pay Rale . Fr= To: Sorting: Ending: Reason for Lowing • 3. Employer Position Held de Duties • Address Phone No. Supervisor Dales Employed Pay Rate Prom: . 7o Startinv Ending Rason for Leaving Have you ever been convicted of a felony or a misdemeanor (other than minor traffic violations)? O Yes 0 No If yes, Please explain: PLEASE READ THIS STATEN-EWE CAREFULLY epee to comply with ell rules of this Company. [understand that any falsification or orrtission of information provided on this application or while i nteniewing will be grounds for dismissal from employment, even if not discovered until after my separation from the Company. !authorize a thorough investigation to be made in conjunction with dais application concerning my character, general ;crab lion, personal chazacteristirs end mode of thing, whichever maybe applicable. I understand this investigation may indudepe-sonal inteniews with third parades, such as family members, business assodates,fmancial sources, Mends, neighbors or others with whom I am acquainted. If lam hired, I agree that my employment and compensation can be terminated with or wi thou' cause and with or without notice at any limeyat the option of the Company or myself. Lunde:stand that noother representadveof theCornpany other than thePresident of N.A. Property, Inc. has the authority to modify this agreement in anyway, and that any such modification must be in a writing signed by both the President and myself. I have read and affirm the above statement as my own. Signature re. 1/5) EFTA00525139 U.S. Department of Justice OW No IIIS.0136 intmigralion and Normalization Service Employment Eligibility Verification Please read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because of a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Verification. To be competed and signed by employee et the time employment begins. Print Name Last Fest Middle Initial Malden Name Address ahem Name and Numbed Apt I Date of Birth (month/my/year) City State Zip Code Social Security • I am aware that federal law provides for i attest, under penalty of perjury, that tam (check one of the following): imprisonment and/or fines for false statements or 0 A citizen or national of the Unite0 States use of false documents in connection with the 0 A Lawful Permanent Resident (Allen d A An alien atehonzed to work until / completion of this form. (Alien 1 or Admission 0) Employee's Signature Date (month/day/year) Preparer and/or Translator Certification. (TO at completed and signed if Seaton l is prepared by a person other then the employee.) arrest. under penalty of perjwy. that !have assisted in the temple ton of this form and that to the best of my know/edge the information is true and collect. Preparees/Transiator's Signature Print Name Address (Strew Name and Number. City. State. Zip Code) Date (monttdday/year) Section 2. Employer Review and Verification. To be completed and stoned by employer. Exam MI one document from List A OR examine one document horn List Et and one from List C, as listed on the reverse of this form, and record the title, number and expiration date, if any, of the document(s) List A OR List B AND List C Document title- Iii Issuing authority: Document I Expiration Date fir airy) /— Document g. ija ,14 Expiration Elate (if any) CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that the obove•listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on (month/day/year) _k_f_ and that to the best of my knowledge the employee is eligible to work in the United States. (State employment agencies may omit the date the employee began employment.) Signature of Employer or Authorized Representative Print Name Title Business or Organization Name Address (Street Name and Number. City. State. Zip Code) Date ImontWaylyead Section 3. Updating and Reverification. To be completed and signed by employer A New Name (if applicable) 8. Date of rehire enondltdaneor) lit applicable) C. If employee's previous grant of work authorization has expired. provide the information below for the document that establishes current employment eligibility. Document Tnie Document e E *ovation Date Of any): f attest, under penalty of perjury. that to the best of my knowledge. this omptoyee it eligible to work in the United States. and if the employee presented document(s), the document(s) f have examined appear to be genuine and to relate to the Individual. Signature of Employer or Authorized Representative Date (month/day/nod Form l•P (Rey II4I•9 //ll Poly 2 EFTA00525140  LISTS OF ACCEPTABLE DOCUMENTS LIST A LIST 8 LIST C Documents that Establish Both Documents that Establish Documents that Establish identity and Employment Identity Employment Eligibility Eligibility OR AND 1. Driver's license or ID card 1. U.S. social security card issued 1. U.S. Passport (unexpired or issued by a state or outlying by the Social Security expired) possession of the United States Administration (other than a card provided it contains a stating it is not valid for photograph or information such as employment) 2. Certificate of U.S. Citizenship name, date of birth, gender, (INS Form N-560 or N-5611 height, eye color and address 2. Certification of Birth Abroad 3. Certificate of Naturalization 2. ID card issued by federal, state issued by the Depanment of (INS Form N-550 or N•570) or local government agencies or State (Form FS•545 or Form entities, provided it contains a DS-13501 photograph or information such as 4. Unexpired foreign passport, name, date of birth, gender, with 1-551 stamp or attached height, eye color and address INS Form l•94 indicating 3. Original or certified copy of a unexpired employment birth certificate issued by a state, 3. School ID card with a authorization county, municipal authority or photograph outlying possession of the United States bearing an official seal 5. Permanent Resident Card or 4. Voter's registration card Alien Registration Receipt Card with photograph (INS Form 5. U.S. Military card or draft record (.151 011-551) 6. Military dependent's ID card 4. Native American tribal document 6. Unexpired Temporary Resident Card (INS Form 1-688) 7. U.S. Coast Guard Merchant Mariner Card 5. U.S. Citizen ID Card (INS Form 7. Unexpired Employment 8. Native American tribal document 1.7971 Authorization Card (INS Form I -688A) 9. Driver's license issued by a Canadian government authority 6. ID Card for use of Resident 8. Unexpired Reentry Permit (INS Citizen in the United States Form I-3271 For persons under age 18 who (INS Form 1-179) are unable to present a document listed above: 9. Unexpired Refugee Travel Document (INS Form 1-5711 7. Unexpired employment 10. School record or report card authorization document issued by 10. Unexpired Employment the INS (other then those listed Authorization Document issued by under List A) the INS which contains a 11. Clinic, doctor or hospital record photograph (INS Form 1-68881 12. Day-care or nursery school record Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274) Fr::= 1 ritRry :0.14/00)Y Nis 3 EFTA00525141  NOTIFICATION/RELEASE OF INFORMATION FORM will be conducted on you in the The purpose of this form is to notify you that consumer report course of consideration for employment with: Last Name: First Name: Middle Name: Social Security #: State of Issue: Current Address: City: State: Zip: In connection with this request I authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts and military services to release information about my background including, but not limited to information about my employment, education, consumer credit history, driving record, criminal record and general public history to the person or company with which this form has been filed, or their agent. This releases the aforesaid parties from any liability and responsibility for collection of the above information. APPLICANT'S SIGNATURE: DATE: EFTA00525142  HBRK Associates Inc. 575 Lexington Avenue, e Floor New York, NY 10022 Phone 212-971-1306 July 26, 2017 Re: Sonam Dema employment via NES LLC Dear Sonam, This letter is to confirm that you were offered Oxford Health Insurance by your employer NES LLC beginning August 1, 2017 however you chose not to enroll in the plan. Please sign below to acknowledge you have declined health insurance. Sirycerely yours, /41 Richard Kahn CPA I, Sonam Dema, have declined enrolling in NES LLC health insurance plan offered by Oxford Health. Sonam Dema EFTA00525143