Form 4020 "Small Business Health Insurance Deduction Information Form" - Alabama

What Is Form 4020?

This is a legal form that was released by the Alabama Department of Revenue - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2013;
  • The latest edition provided by the Alabama Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 4020 by clicking the link below or browse more documents and templates provided by the Alabama Department of Revenue.

ADVERTISEMENT
ADVERTISEMENT

Download Form 4020 "Small Business Health Insurance Deduction Information Form" - Alabama

Download PDF

Fill PDF online

Rate (4.7 / 5) 59 votes
A
D
R
FORM
LABAMA
EPARTMENT OF
EVENUE
4020
I
& C
T
D
NDIVIDUAL
ORPORATE
AX
IVISION
9/13)
Small Business Health Insurance
Deduction Information Form
Employer
(Please check box if statement applies to you.)
My company employs less than 25 employees, and I comply with the rules as described in
Regulation 810-3-15.3-.01 administered by the Alabama Department of Revenue.
Under penalties of perjury, I declare that the information above is true and correct to the best of
my knowledge.
_____________________________________________ _____________________________ ________________
Signature
Title
Date
Employee
(Please check all boxes that apply to you.)
I am a resident of Alabama.
I earn no more than $50,000 in wages from the above “qualifying employer.”
I have total adjusted gross income of no more than $75,000 if filing single or $150,000 if married
filing jointly.
Under penalties of perjury, I declare that the information above is true and correct to the best of
my knowledge.
___________________________________________________________ _____________________________
Signature
Date
Employers and Employees should each retain a copy of this form for their records.
For specific questions regarding this Act 2011-155, you may call
(334) 242-1099 regarding individual income tax,
(334) 242-1200 regarding corporate income tax, or
(334) 242-1033 regarding pass through entities.
A
D
R
FORM
LABAMA
EPARTMENT OF
EVENUE
4020
I
& C
T
D
NDIVIDUAL
ORPORATE
AX
IVISION
9/13)
Small Business Health Insurance
Deduction Information Form
Employer
(Please check box if statement applies to you.)
My company employs less than 25 employees, and I comply with the rules as described in
Regulation 810-3-15.3-.01 administered by the Alabama Department of Revenue.
Under penalties of perjury, I declare that the information above is true and correct to the best of
my knowledge.
_____________________________________________ _____________________________ ________________
Signature
Title
Date
Employee
(Please check all boxes that apply to you.)
I am a resident of Alabama.
I earn no more than $50,000 in wages from the above “qualifying employer.”
I have total adjusted gross income of no more than $75,000 if filing single or $150,000 if married
filing jointly.
Under penalties of perjury, I declare that the information above is true and correct to the best of
my knowledge.
___________________________________________________________ _____________________________
Signature
Date
Employers and Employees should each retain a copy of this form for their records.
For specific questions regarding this Act 2011-155, you may call
(334) 242-1099 regarding individual income tax,
(334) 242-1200 regarding corporate income tax, or
(334) 242-1033 regarding pass through entities.