Form Mo W-4 - Employee'S Withholding Allowance Certificate

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MISSOURI DEPARTMENT OF REVENUE
This certificate is for income tax withholding
MO W-4
TAX ADMINISTRATION BUREAU
and child support enforcement purposes only.
EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE
(REV. 7-97)
PLEASE TYPE OR PRINT.
FULL NAME
SOCIAL SECURITY NUMBER
MARITAL STATUS (If married but
SINGLE
legally separated or spouse is a non-
resident alien, check the single box.)
MARRIED
HOME ADDRESS (NUMBER AND STREET OR RURAL ROUTE)
CITY OR TOWN, STATE AND ZIP CODE
1. Allowance for yourself – enter 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Allowance for your spouse – enter 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
3. Allowance(s) for dependent(s) – you are entitled to claim an allowance for each dependent you will be able to claim
on your federal income tax return. Do not include yourself or spouse — enter the number of dependents . . . . . . . . . . . . . . . . . . . . .
3.
4. Allowances for itemized deductions (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
5. TOTAL – Add Lines 1 through 4 above – enter “SAME” if claiming same number of Federal allowances. . . . . . . . . . . . . . . . . . . . . . . 5.
6. Additional amount per pay period you want deducted
$
7. I claim complete “Exempt” status from withholding because (see instructions and check boxes below that apply)
A.
Last year I did not owe any Missouri income tax and had a right to a full refund of all income tax withheld, and
B.
This year I do not expect to owe any Missouri income tax and expect to have a right to a full refund of all income tax withheld. If both “A” and “B”
apply, enter the year effective and “EXEMPT” here
C.
If you entered “EXEMPT” on Line 7b, are you a full time student?
Yes
No
Under the penalties of perjury, I certify that to the best of my knowledge and belief, the amount of withholding claimed on this certificate does not exceed the number to which I am entitled.
EMPLOYEE’S SIGNATURE
DATE
EMPLOYER’S NAME
FEDERAL EMPLOYER IDENTIFICATION NUMBER
EMPLOYER’S ADDRESS
MISSOURI TAX IDENTIFICATION NUMBER
NOTICE TO EMPLOYER: A copy of this form must be sent within 20 days after the employer hires the employee to: Missouri Department of Revenue, P.O. Box 3340, Jefferson City, MO 65105-3340
MO 860-1598 (7-97)
— DETACH HERE. GIVE CERTIFICATE TO EMPLOYER AND KEEP BOTTOM PORTION FOR YOUR RECORDS —
MISSOURI DEPARTMENT OF REVENUE
EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE
GENERAL INSTRUCTIONS
Those persons who qualify as your dependents
period. If your employer agrees to this additional
WHO MUST FILE:
for federal income tax purposes may also be
withholding, enter the additional amount you want
All employees are required to file a completed
claimed as dependents for Missouri purposes.
deducted from each paycheck on Line 6.
Form MO W-4. This form will be used by your
The term “dependent” does not include you or
employer to determine the amount of Missouri
LINE 7:
your spouse. Indicate the number of dependents
income tax to be withheld from your paycheck. If
Exempt from Withholding – You may claim an
that you are claiming on Line 3.
you have more than one employer, you should
“Exempt” status from withholding of Missouri income
claim a smaller number or no allowances on each
LINE 4:
tax if last year you did not owe any Missouri income
Form MO W-4 filed with employers other than
Allowance for Missouri Estimated Itemized De-
tax and had a right to a refund of all income tax
your principal employer so that the total amount
ductions – If you expect to itemize deductions
withheld and this year you do not expect to owe any
withheld will be closer to your actual income tax
on your Missouri income tax return, you may
Missouri income tax and expect to have a right to a
liability.
claim additional allowances. Refer to the follow-
refund of all income tax withheld. You may not claim
ing worksheet.
“Exempt” if your return shows a tax liability before
NOTE: If claiming the same number of allow-
the allowance of any credit for income tax withheld.
ances for Missouri personal income tax as
(A) Enter total amount of
If you are exempt, your employer will not withhold
Federal income tax, write “SAME” on Line 5
estimated itemized deductions $
Missouri income tax from your wages.
of this form.
(B) Enter amount of your
standard deduction using the
You must revoke this “Exempt” status (1) within 10
WHEN TO FILE YOUR ALLOWANCE
following information:
$
days from the time you anticipate you will incur
CHANGES:
• If single or head of
income tax liability for the year or (2) on or before
You must file a new certificate within 10 days if
household, enter $4,150.00
December 1 if you anticipate you will incur Missouri
the number of allowances previously claimed by
• If married filing joint, married
Income Tax Liability for the next year. If you want to
you decreases.
filing separate or qualifying
revoke this “Exempt” status, you must file a new
You may file a new certificate at any time if the
widow(er), enter $3,450.00.
Form MO W-4 with your employer showing the
number of your allowances increases.
(C) Subtract Line (B) from Line (A)
number of withholding allowances you are entitled
and enter the difference or
to claim. A certificate claiming “Exempt Status” will
zero, whichever is greater
$
expire on December 31, of each year and a new
HOW TO COMPLETE FORM MO W-4
(D) Additional Allowances - Divide
Form MO W-4 is required for the next year.
LINES 1 THROUGH 3:
the amount on Line (C) by
EMPLOYER INFORMATION:
Number of Allowances – You may claim the
$400.00, round to the nearest
Each employer must provide their name, address,
same number of allowances on the Form MO
whole number and enter here
Federal Employer Identification Number and
W-4 as claimed on the Federal Form W-4. If you
and on Line 4.
Missouri Tax Identification Number in the spaces
expect to owe more income tax for the year than
LINE 6:
provided. Upon completion of Form MO W-4 the
will be withheld and you claim every allowance to
Additional Withholding – If you have claimed
employer must submit the form for each “new hire”
which you are entitled, you may increase your
“zero” allowances on Line 1, but still expect to
within 20 days after the employer hires the
withholding by claiming a smaller number of
have a balance due on your tax return for the
employee. Mail Form MO W-4 to the Missouri
allowances on Form MO W-4 or you may enter
year, you may wish to request your employer to
Department of Revenue, P.O. Box 3340, Jefferson
into an agreement with your employer to have
withhold an additional amount of tax for each pay
City, MO 65105-3340.
additional amounts withheld (See Line 6).
MO 860-1598 (7-97)
This publication is available upon request in alternative accessible format(s).

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