---
type: tax-form
category: employment
person: Xuewei Jiang
date: 2020-05-29
provider: University of Southern California
source: jiang_w4_usc_2020.pdf
---

# Form W-4 -- Employee's Withholding Certificate (2020) -- Signed Copy

Form W-4 (2020)
Department of the Treasury, Internal Revenue Service
OMB No. 1545-0074

## Step 1: Enter Personal Information

| Field | Value |
|-------|-------|
| (a) First name and middle initial | Xuewei |
| Last name | Jiang |
| (b) Social security number | 092-99-3215 |
| Address | 1000 Escalon Ave. Apt. K2087 |
| City or town, state, and ZIP code | Sunnyvale, CA 94085 |

(c) Filing Status:
- [ ] Single or Married filing separately
- [x] Married filing jointly (or Qualifying widow(er))
- [ ] Head of household

## Step 2: Multiple Jobs or Spouse Works

(Not filled in)

## Step 3: Claim Dependents

| Field | Value |
|-------|-------|
| Qualifying children under age 17 x $2,000 | (blank) |
| Other dependents x $500 | (blank) |
| Total (line 3) | $  |

Note: Box shows "3" with "$" but amount field appears blank/unclear.

## Step 4 (optional): Other Adjustments

| Field | Value |
|-------|-------|
| 4(a) Other income | $ (blank) |
| 4(b) Deductions | $ (blank) |
| 4(c) Extra withholding | $ (blank) |

## Step 5: Sign Here

| Field | Value |
|-------|-------|
| Employee's signature | (signed -- cursive signature) |
| Date | 05/29/2020 |

## Employers Only

| Field | Value |
|-------|-------|
| Employer's name and address | (blank) |
| First date of employment | (blank) |
| Employer identification number (EIN) | (blank) |

Cat. No. 10220Q
Form W-4 (2020)