TD4 Declaration of Exemption - Employment at a Special Work Site

You use this form if you are an employee who works at a special work site. It will allow your employer to determine if the certain benefits can be excluded from income.

Ways to get the form

• Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (td4-fill-23e.pdf)

• Print and fill out by hand

  • Standard print PDF (td4-23e.pdf)

• Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities