Form Msr - Claim Of Exemption For A Nonmilitary Spouse printable pdf download

Form Msr - Claim Of Exemption For A Nonmilitary Spouse

FORM MSR

PAGE 2 of 2

Section I – Claim of Exemption for a Nonmilitary Spouse

You need to complete this section to prevent your employer from withholding Montana income tax

from compensation that is exempt from Montana income tax under the MSRRA. This exemption is for

the calendar year that you indicate below. Please note: If you do not complete “Year the exemption is

applicable,” the certiﬁ cate is not valid and withholding is required.

I, ________________________________________________________, certify that:

1. I am the spouse of a servicemember who is in Montana in compliance with military orders.

2. My spouse and I are legal residents (domiciliaries) of the state of _______________________ .

3. I am in Montana solely to be with my spouse.

_____________ Year the exemption is applicable (you need to complete a new certiﬁ cate each year).

I declare under penalty of law (45-7-203, MCA – unsworn falsiﬁ cation to authorities) that I have

examined this certiﬁ cate and to the best of my knowledge and belief, it is true, correct, and complete.

______________________________________

_________________ ______________________

Signature

Date

Social Security Number

Section II – Notice of Ineligibility for a Nonmilitary Spouse

You should complete this section if you become ineligible for exemption under the MSRRA during the

calendar year for which you have claimed exemption.

I am no longer eligible for the exemption from withholding of Montana income tax under the Military

Spouses Residency Relief Act.

______________________________________

_________________ ______________________

Signature

Date

Social Security Number

Section III – Employer Veriﬁ cation

Please verify that the nonmilitary spouse provided proof of the following documentation with Form

MSR.

 Service member’s latest Leave and Earnings Statement (LES).

 Nonmilitary spouse’s military I.D., which clearly identiﬁ es the spouse as a spouse of the

service member.

______________________________________

_________________

Signature

Date

Form Msr - Claim Of Exemption For A Nonmilitary Spouse