Form Mo W-4c - Withholding Affidavit For Missouri Residents - 2013
Download a blank fillable Form Mo W-4c - Withholding Affidavit For Missouri Residents - 2013 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Mo W-4c - Withholding Affidavit For Missouri Residents - 2013 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Reset Form
Print Form
Missouri Department of Revenue
Withholding Affidavit
Form
For Missouri Residents
MO W-4C
This form is to be completed by a Missouri resident employed in a foreign state.
Employer: Please retain this Form MO W-4C for your records. Do not send a copy to the Department of Revenue unless requested to
do so.
Name
Missouri Tax Identification Number
|
|
|
|
|
|
|
Street Address
City
State
Zip Code
Name
Social Security Number
|
|
|
|
|
|
|
|
Street Address
City
State
Zip Code
I realize that a Missouri resident is required to file an individual income tax return with the Missouri Department of Revenue by April
15 of each year and report income from all sources. For withholding purposes however;
1. 100% of services for this employer are performed in the state of ____________________________ and income taxes are being
withheld by this employer for that state. I will attach to my Missouri individual income tax return, a copy of the return I file with that
state. Based on this sworn information, I hereby request no Missouri income tax be withheld from my wages.
2. _______ % of services for this employer are performed in the state of Missouri and are subject to Missouri withholding tax. Based
on this sworn information, I hereby request that Missouri tax be withheld on this pro rata share.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I am a Missouri
resident and an employee of the employer listed above.
Signature
Title
Printed Name
Date (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Form MO W-4C (Revised 11-2013)
Mail to:
Taxation Division
Phone: (573) 751-8750
TDD: (800) 735-2966
P.O. Box 999
Visit
Jefferson City, MO 65108-0999
Fax: (573) 522-6816
for additional information.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial