Form Mhw-4 - Employee'S Withholding Certificate For City Of Muskegon Heights Income Tax
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1
2MHW-4
RESIDENT
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF MUSKEGON HEIGHTS INCOME TAX
NON-RESIDENT
1. PRINT FULL NAME
SOCIAL SECURITY NO.
OFFICE, PLANT, DEPT.
EMPLOYEE IDENTIFICATION NO.
2. ADDRESS, NUMBER AND STREET
CITY, TOWNSHIP OR VILLAGE WHERE YOU RESIDE
STATE
ZIP CODE
3. PREDOMINANT PLACE OF EMPLOYMENT
CITY
UNDER
25%
40%
60%
80%
100%
Print name of each city where you work for this employer
CITY
UNDER
and circle closest % of total earnings in each.
25%
40%
60%
80%
100%
}
4. EXEMPTIONS FOR
YOUR WITHHOLDING
Check
Enter number of
YOURSELF
exemptions checked
EXEMPTIONS:
blocks
which
5. EXEMPTIONS FOR
(See instructions
Enter number of
apply
YOUR SPOUSE
exemptions checked
on reverse side.)
6. (a) EXEMPTIONS FOR
NUMBER
6. (b) EXEMPTIONS FOR YOUR
NUMBER
EMPLOYEE: File this form with your employer.
Enter total of line 6
YOUR CHILDREN
OTHER DEPENDENTS
(a plus b)
Otherwise he must withhold CITY OF
MUSKEGON HEIGHTS income tax from your
7. ADD THE NUMBER OF EXEMPTIONS WHICH YOU HAVE CLAIMED ON LINES 4, 5 AND 6 ABOVE AND WRITE THE TOTAL
earnings without exemption.
EMPLOYER: Keep this certificate with your
I certify that the information submitted on this certificate is true, correct and complete to the best of my
records. If the information submitted by the
knowledge and belief.
employee is not believed to be true, correct
8. DATE
SIGNATURE
and complete. The Administrator must be so
advised.
MHW-4
RESIDENT
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF MUSKEGON HEIGHTS INCOME TAX
NON-RESIDENT
1. PRINT FULL NAME
SOCIAL SECURITY NO.
OFFICE, PLANT, DEPT.
EMPLOYEE IDENTIFICATION NO.
2. ADDRESS, NUMBER AND STREET
CITY, TOWNSHIP OR VILLAGE WHERE YOU RESIDE
STATE
ZIP CODE
3. PREDOMINANT PLACE OF EMPLOYMENT
CITY
UNDER
25%
40%
60%
80%
100%
Print name of each city where you work for this employer
CITY
UNDER
and circle closest % of total earnings in each.
25%
40%
60%
80%
100%
}
4. EXEMPTIONS FOR
YOUR WITHHOLDING
Check
Enter number of
YOURSELF
exemptions checked
EXEMPTIONS:
blocks
which
5. EXEMPTIONS FOR
(See instructions
Enter number of
apply
YOUR SPOUSE
exemptions checked
on reverse side.)
6. (a) EXEMPTIONS FOR
NUMBER
6. (b) EXEMPTIONS FOR YOUR
NUMBER
EMPLOYEE: File this form with your employer.
Enter total of line 6
YOUR CHILDREN
OTHER DEPENDENTS
(a plus b)
Otherwise he must withhold CITY OF
MUSKEGON HEIGHTS income tax from your
7. ADD THE NUMBER OF EXEMPTIONS WHICH YOU HAVE CLAIMED ON LINES 4, 5 AND 6 ABOVE AND WRITE THE TOTAL
earnings without exemption.
EMPLOYER: Keep this certificate with your
I certify that the information submitted on this certificate is true, correct and complete to the best of my
records. If the information submitted by the
knowledge and belief.
employee is not believed to be true, correct
8. DATE
SIGNATURE
and complete. The Administrator must be so
advised.
MHW-4
RESIDENT
EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF MUSKEGON HEIGHTS INCOME TAX
NON-RESIDENT
1. PRINT FULL NAME
SOCIAL SECURITY NO.
OFFICE, PLANT, DEPT.
EMPLOYEE IDENTIFICATION NO.
2. ADDRESS, NUMBER AND STREET
CITY, TOWNSHIP OR VILLAGE WHERE YOU RESIDE
STATE
ZIP CODE
3. PREDOMINANT PLACE OF EMPLOYMENT
CITY
UNDER
25%
40%
60%
80%
100%
Print name of each city where you work for this employer
CITY
UNDER
and circle closest % of total earnings in each.
40%
60%
80%
100%
25%
}
4. EXEMPTIONS FOR
YOUR WITHHOLDING
Check
Enter number of
YOURSELF
exemptions checked
EXEMPTIONS:
blocks
which
5. EXEMPTIONS FOR
(See instructions
Enter number of
apply
YOUR SPOUSE
exemptions checked
on reverse side.)
6. (a) EXEMPTIONS FOR
NUMBER
6. (b) EXEMPTIONS FOR YOUR
NUMBER
EMPLOYEE: File this form with your employer.
Enter total of line 6
YOUR CHILDREN
OTHER DEPENDENTS
(a plus b)
Otherwise he must withhold CITY OF
MUSKEGON HEIGHTS income tax from your
7. ADD THE NUMBER OF EXEMPTIONS WHICH YOU HAVE CLAIMED ON LINES 4, 5 AND 6 ABOVE AND WRITE THE TOTAL
earnings without exemption.
EMPLOYER: Keep this certificate with your
I certify that the information submitted on this certificate is true, correct and complete to the best of my
records. If the information submitted by the
knowledge and belief.
employee is not believed to be true, correct
8. DATE
SIGNATURE
and complete. The Administrator must be so
advised.
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