Form W-221 - Nonresident Military Spouse Withholding Exemption
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Nonresident Military Spouse
Withholding Exemption
Legal last name
Legal first name
M.I.
Social Security Number
Address (number and street)
City or Post Office
State
Zip code
I certify that:
• I am a legal resident (domiciliary) of the state of
,
• My spouse is a member of the armed forces and is present in Wisconsin in compliance with
military orders, and
• I am present in Wisconsin solely to be with my spouse.
I no longer qualify for the exemption as of
,
Date
Under penalties of perjury, I declare that the above information is true, correct, and complete to the best of
my knowledge and belief.
Name
Date
SIGN
HERE
Employees
Employers
A spouse of a servicemember may be exempt from Wisconsin income
Employer Name
tax on wages performed in Wisconsin if (1) the servicemember is
present in Wisconsin in compliance with military orders, (2) the
spouse is in Wisconsin solely to be with the servicemember, and
Employer Address
(3) the spouse maintains a domicile (legal residence) in another state.
If you meet these requirements, you may claim an exemption from
Wisconsin withholding of income tax on wages earned in Wisconsin.
Complete, sign, and date this form to claim an exemption from with‑
holding. Give the completed form to your employer.
Check the above box if you no longer qualify for the exemption.
Employer Federal ID Number
For example, you would check the box if you changed your legal
residence to Wisconsin or separated from your spouse. You may be
required to complete a Wisconsin Form WT‑4, Employees Wisconsin
Withholding Exemption Certificate, and submit it to your employer
Upon receipt of the completed and signed form, you are no longer
so that the correct amount of Wisconsin income tax can be withheld
required to withhold Wisconsin income tax for wages earned by this
from your wages.
person.
Note If at any time you change your legal residence to Wisconsin, it
Send a copy of the completed form to:
is your responsibility to contact your employer to begin withholding
Wisconsin income tax.
Wisconsin Department of Revenue
Office Services MS 5‑144
If your employer has withheld Wisconsin income tax while you
PO Box 8906
qualify for the exemption, you must file a Wisconsin income tax
Madison WI 53708‑8906
return (Form 1NPR), during the regular filing season, requesting a
refund of the withheld taxes.
You may also FAX the form to us: (608) 267‑0834.
If you have questions, contact the Department of Revenue at
If you have questions, contact the Department of Revenue at
(608) 266‑2772 or by e‑mail at: income@revenue.wi.gov.
(608) 266‑2776 or by e‑mail at: sales10@revenue.wi.gov.
W-221 (N. 1-10)
Wisconsin Department of Revenue
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