1. If you wish to claim yourself, write “1”

2. If you are married and your spouse is not claimed on his or her own certificate, write “1”

3. Write the number of dependents you will be allowed to claim on your income tax return (do not include your spouse)

4. Subtotal Personal Exemptions (add lines 1 through 3)

5. Exemptions for age

(a) If you will be 65 or older on January 1, write “1”

(b) If you claimed an exemption on line 2 and your spouse will be 65 or older on January 1, write “1”

6. Exemptions for blindness

(a) If you are legally blind, write “1”

(b) If you claimed an exemption on line 2 and your spouse is legally blind, write “1”

7. Subtotal exemptions for age and blindness (add lines 5 through 6)

8. Total of Exemptions - add line 4 and line 7

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