Form Mi-W4 - Employee'S Michigan Withholding Exemption Certificate

MI-W4

EMPLOYEE'S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE

STATE OF MICHIGAN - DEPARTMENT OF TREASURY

(Rev. 11-99)

This certificate is for Michigan income tax withholding purposes only. You must file a revised

form within 10 days if your exemptions decrease or your residency status changes from

nonresident to resident. Read instructions on back before completing this form.

1. Social Security Number

2. Date of Birth

Issued under P.A. 281 of 1967. Filing is mandatory.

Type or Print Your First Name, Middle Initial and Last Name

4. Driver License Number

Home Address (No., Street, P.O. Box or Rural Route)

Are you a new employee?

Yes

If yes, enter date of hire . . . .

City or Town

State

ZIP Code

Enter the number of personal and dependency exemptions you are claiming

Additional amount you want deducted from each pay

(if employer agrees)

.00

I claim exemption from withholding because (see instructions):

A Michigan income tax liability is not expected this year.

Wages are exempt from withholding. Explain: _______________________________________________________

Permanent home (domicile) is located in the following Renaissance Zone: _________________________________

Under penalty of perjury, I certify that the number of withholding exemptions claimed on this certificate does

not exceed the number to which I am entitled. If claiming exemption from withholding, I certify that I anticipate

EMPLOYEE:

that I will not incur a Michigan income tax liability for this year.

If you fail or refuse to file this form, your

employer must withhold Michigan income tax

Date

Employee's Signature

from your wages without allowance for any

exemptions. Keep a copy of this form for your

records.

Employer: Complete lines 10 and 11 before sending to the Michigan Department of Treasury.

INSTRUCTIONS TO EMPLOYER:

Employers must report all new hires to the

10.

Employer's Name, Address, Phone No. and Name of Contact Person

State of Michigan. Keep a copy of this

certificate with your records. If the employee

claims more

than

nine personal and

dependency exemptions or claims a status

Federal Employer Identification Number

exempting the employee from withholding, you

11.

must file their original MI-W4 form with the

Michigan Department of Treasury.

INSTRUCTIONS TO EMPLOYEE

You must submit a Michigan withholding exemption certificate

If you hold more than one job, you may not claim the same

(form MI-W4) to your employer on or before the date that

exemptions with more than one employer. If you claim the same

employment begins. If you fail or refuse to submit this certificate,

exemptions at more than one job, your tax will be under withheld.

your employer must withhold tax from your compensation without

allowance for any exemptions. Your employer is required to notify

Line 7: You may designate additional withholding if you expect to

the Michigan Department of Treasury if you have claimed more

owe more than the amount withheld.

than nine dependency exemptions or claimed a status which

exempts you from withholding.

Line 8: You may claim exemption from Michigan income tax

withholding ONLY if you do not anticipate a Michigan income tax

You MUST file a new MI-W4 within 10 days if your residency

liability for the current year because all of the following exist: a) your

status changes or if your exemptions decrease because: a) your

employment is less than full time, b) your personal and dependency

spouse, for whom you have been claiming an exemption, is

divorced or legally separated from you or claims his/her own

exemption allowance exceeds your annual compensation, c) you

exemption(s) on a separate certificate, or b) a dependent must be

claimed exemption from federal withholding, d) you did not incur a

dropped for federal purposes.

Michigan income tax liability for the previous year. You may also

claim exemption if your permanent home (domicile) is located in a

Line 5: If you check "yes," enter your date of hire (mo/day/year).

Renaissance Zone. For more information on Renaissance Zones

call the Michigan Tele-Help System, 1-800-827-4000, and listen to

Line 6: Personal and dependency exemptions. The total number

topic 293. Full-time students cannot claim exempt status.

of exemptions you claim on the MI-W4 may not exceed the

number of exemptions you are entitled to claim when you file your

Web Site

Michigan individual income tax return.

Visit our Treasury web site on the Internet at:

If you are married and you and your spouse are both

employed, you both may not claim the same exemptions with

each of your employers.

Form Mi-W4 - Employee'S Michigan Withholding Exemption Certificate - 1999

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