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*LG Resources participates in the Work Opportunity Tax Credit (WOTC) program. Please complete the questionnaire by clicking the button below. Your answers will be kept confidential and will not impact your employment opportunity with LG Resources.

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Form W-4 (2016)

Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2016 expires February 16, 2016. See Pub. 505, Tax Withholding and Estimated Tax.

Note. If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends).

Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee:

  • Is age 65 or older
  • Is blind, or
  • Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return.

The exceptions do not apply to supplemental wages greater than $1,000,000.

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

Head of household.Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information.

Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.

Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P.

Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details.

Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Check your withholding.After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for 2016. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married).

Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at

Personal Allowances Worksheet (Keep for your records.)
A Enter “1” for yourself if no one else can claim you as a dependent.
Enter “1” if  :
  • You are single and have only one job; or
  • You are married, have only one job, and your spouse does not work, or
  • Your wages from a second job or your spouse ′s wages (or the total of both) are $1,500 or less.
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.).
Enter number of dependents (other than your spouse or yourself) you will claim on your tax return.
Enter “1 ” if you will file as head of household on your tax return (see conditions under Head of household above.) . .
Enter “1 ” if you have at least $2,000 of child or dependent care expenses,for which you plan to claim a credit . . .(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
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 $65,000 ($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 $65,000 and $84,000 ($100,000 and $119,000 if married), enter “1 ” for each eligible child.
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.) ▶
For accuracy, complete all worksheets that apply.   
  • If you plan to itemized or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2.
  • If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 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.-----------------------
Form W-4
Department of the Treasury
Internal Revenue Service

Employee’s Withholding Allowance Certificate

▶ Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
OMB No. 1545-0074
1  Your First name and Middle initial*
Last name*
2  Your Social Security no*
Home address (Number & street or rural routes)*
City or town, state, and ZIP code*
3. * Single Married Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single ” box.
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. ▶
5.  Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 
6.  Additional amount, if any, you want withheld from each paycheck.
7.  I claim exemption from withholding for 2016, 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 ... ▶
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 form is not valid unless you sign it.) ▶
8.  Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)
9.  Office code (optional)
10.  Employer identification number (EIN)
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2016)
Form W-4 (2016) 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
  1. Enter an estimate of your 2016 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1951) of your income, and miscellaneous deductions. For 2016, you may have to reduce your itemized deductions if your income is over $309,900 and you are married filing jointly or are a qualifying widow(er); $284,050 if you are head of household; $258,250 if you are single and not head of household or a qualifying widow(er); or $154,950 if you are married filing separately. See Pub. 505 for details ....
1  $
2 Enter if  :
  • $12,600 if married filing jointly or qualifying widow(er)
  • $9,250 if head of household
  • $6,300 if single or married filing separately
2  $
3 Subtract line 2 from line 1. If zero or less, enter “-0- ” .....
3 $
Enter an estimate of your 2016 adjustments to income and any additional standard deduction (see Pub. 505)
4  $
Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to
Withholding Allowances for 2016 Form W-4 worksheet in Pub. 505.) ............
5  $
Enter an estimate of your 2016 nonwage income (such as dividends or interest)........
6  $
Subtract line 6 from line 5. If zero or less, enter “-0- ” ................
7  $
8 Divide the amount on line 7 by $4,000 and enter the result here. Drop any fraction .......
Enter the number from the Personal Allowances Worksheet, line H, page 1 .........
10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/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
Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)
Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet
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 ” ...
3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0- ”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet .........
 Note. If line 1 is less than line 2, enter “-0- ” 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.
Enter the number from line 2 of this worksheet ...
5 Enter the number from line 1 of this worksheet ..........
6 Subtract line 5 from line 4 ...
Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here ....
7 $
Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed ..
8 $
Divide line 8 by the number of pay periods remaining in 2016. 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 2016. 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
Married Filing Jointly All Others
If wages from LOWEST paying job are– Enter on line 2 above If wages from LOWEST paying job are– Enter on line 2 above
$0 - $6,000
6,001 - 13,000
13,001 - 24,000
24,001 - 26,000
26,001 - 34,000
34,001 - 44,000
44,001 - 50,000
50,001 - 65,000
65,001 - 75,000
75,001 - 80,000
80,001 - 100,000
100,001 - 115,000
115,001 - 130,000
130,001 - 140,000
140,001 - 150,000
150,001 and over
$0 - $8,000
8,001 - 17,000
17,001 - 26,000
24,001 - 26,000
26,001 - 34,000
34,001 - 44,000
44,001 - 75,000
75,001 - 85,000
85,001 - 110,000
110,001 - 125,000
125,001 - 140,000
140,001 and over
Table 2
Married Filing Jointly All Others
If wages from HIGHEST paying job are- Enter on line 7 above If wages from HIGHEST paying job are- Enter on line 7 above
$0 - $75,000
75,001 - 135,000
135,001 - 205,000
205,001 - 360,000
360,001 - 405,000
405,001 and over
$0 - $38,000
38,001 - 83,000
83,001 - 180,000
180,001 - 395,000
395,001 and over
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return..

Employment Eligibility Verification

Department of Home Land Security Services

U.S. Citizenship and Immigration Services

OMB No. 1615-0047
Expires 08/31/2019

▶ START HERE.Read instructions carefully before completing this form .The instructions must be available, either in paper or electronically,during completion of this form.Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals.Employers CANNOT specify which document(s) may present to establish authorization and identity.The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section.1 Employee Information and Attestation (Employees must complete and sign section 1 of FormI-9 no later than the first day of employment but not before accepting a job offer.)
Last Name(Family Name)*
First Name(Given Name)*
Middle Initial
Other Names Used(if any)
Address(Street Number and Name)*
Apt. Number
City Or Town*
ZIP Code*
Date of Birth (mm/dd/yyyy)*
U.S Social Security Number*
Employee's E-mail address*
Employee's Telephone Number*
Acceptable Characters ( ) - + and space

I am aware that federal law provides for imprisonment and /or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

  • 1. A citizen of the United States
  • 2. A noncitizen national of the United States (See Instructions)
  • 3. A lawful permanent resident (Alien Registration Number/ USCIS Number):
  • 4. An alien authorized to work until(expiration date if applicable mm/dd/yyyy):
    Some aliens may write “N/A ” in expiration date field.(See Instructions)
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
1.Alien Registration Number/USCIS Number:
2.Form I-94 Admission Number:
3.Foreign Passport Number :
Country Of Insurance :
QR Code-Section 1 Do not write in This Space
Signature of Employee* Today's Date(mm/dd/yyyy)*
Preparer and/or Translator Certification (check one) :
I did not use a preparer or translator A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Last Name(Family Name)
First Name(Given Name)
Address(Street Number and Name)
City Or Town
ZIP Code
Employer Complete Next Page
Form I-9 11/14/16   N

LG Resources is an equal opportunity employer and does not discriminate against any applicant or employee based on race, color, religion, sex, national origin, disability, age or military or veteran status in accordance with federal law. An Employee Handbook has been created to outline working conditions, policies, procedures, appeal processes and benefits.
Click here to read the LG Resources Employee Handbook for details and
Spanish Version respectively.
* I have read the LG Resources Employee Handbook and agree to the terms and conditions set therein. I also agree to have LG Resource remove $20 from my first paycheck to cover my new employee processing set up fee.
* I have read the LG Resources No Harassment Policy, understand it and agree to follow it.
* I certify that I am 18 years of age or older and that the information on this application is true and factual and understand that completing this application does not signify an employment relationship with LG Resources until ID verification, background check, drug test and placement interview has been successfully completed.