Form K-4U Allowance from Unemployment Benefits

DATE: (Rev 5/11) CANCELLATION CLAIMANT S I authorize the Kansas Department of Labor to withhold 3 5% of my weekly unemployment insurance benefit to be remitted to the Kansas Department of Revenue for my state income tax obligation I understand the deduction will be made from benefits paid to me after the date of this agreement or as soon as is reasonable for the Kansas Department of Labor to update my file to reflect this agreement I hereby cancel my authorization for the Kansas Department of Labor to deduct 3 5% of my weekly unemployment insurance benefit for my Kansas income tax obligation I understand this action will be effective the date of the agreement or as soon as is reasonable for the Kansas Department of Labor to update my file to reflect the change Kansas Unemployment Contact Center Kansas Withholding from Mailing Address P O Box 3539 Topeka KS 66601 3539Fax: (785) 296 3249 SIGNATURE ` This authorization will remain in effect until the Kansas Department of Labor receives written notice from me to cancel the agreement Unemployment benefits you receive are considered taxable income for federal and state income tax purposes To authorize state tax withholding from your benefits complete this form and mail or fax it to the unemployment call center (see address and fax number below) Unemployment Insurance Benefits