Looking for a Mississippi Withholding Form Templates? Download it for free!

Form 89-350-10-2 Rev.1/10

Department of Revenue

P.O. Box 960

MISSISSIPPI EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE

Jackson Mississippi 39205

IMPORTANT: THIS CERTIFICATE MAY BE USED FOR PAY PERIODS IN CALENDAR YEAR 2010 and after

Employee's Name

SSN

Employee's Residence Address

Number and Street

City or Town

State

Zip Code

CLAIM YOUR WITHHOLDING PERSONAL EXEMPTION

Marital Status

Personal Exemption Allowed

Amount Claimed

1.Single

( )Enter $6,000 as exemption................................

EMPLOYEE:

File this form with

(a)

your employer.

( )Spouse NOT employed:Enter$12,000.........................

Otherwise, he must

2.Married

withhold Mississippi

(Check

(b)

( )Spouse IS employed: Enter that part of $12,000 claimed by

income tax from the

One)

you, in multiples of $500. See instructions 2(b)below.......

full amount of your

wages.

( )Enter $9,500 as exemption. To qualify as head of family,

you must be single and have a dependent living in the home

Head of

with you. See instructions 2(c) & (d)

Family

below.......................................................

You may claim $1,500 for each dependent,* other than for

4. Dependents

taxpayer and spouse, who receives chief support from you and

EMPLOYER:

who qualifies as a dependent for Federal income tax purposes.

Keep this certificate

*A head of family may claim $1,500 for each dependent

with your records. If

excluding the one which qualifies you as head of family.

Number Claimed

the employee is

Multiply number of dependents claimed by you by $1,500. Enter

believed to have

amount claimed..............................................

claimed excess

exemption, the State

Age 65 or older

( )Husband

( )Wife

( ) Single

Tax Commission should

Blind

( )Husband

( )Wife

( ) Single

be advised.

5. Age and

Multiply number of blocks checked by $1,500. Enter amount

Blindness

claimed.....................................................

Exemption

Note: No exemption allowed for age or blindness for

dependents.

6. TOTAL AMOUNT OF EXEMPTION CLAIMED - Lines 1 through 5....................

Effective only for

pay periods in 2000

7. Additional dollar amount withholding per pay period if agreed to by

and after

your employer............................................................

Military Spouses

If you meet the conditions set forth under the Service Member Civil Relief,

Residency Relief Act

as amended by the Military Spouses Residency Relief Act and have no

Exemption from

Mississippi tax liability, write "Exempt" on line 8. You must attach a copy

Mississippi

of the Federal Form DD-2058 and a copy of your Military Spouse ID Card to

Withholding

this form so your employer can validate the exemption claim......

I declare under the penalties imposed for filing false reports that the amount of exemption claimed on this certificate does

not exceed the amount to which I am entitled or I am entitled to claim exempt status.

Employee's Signature:

Date:

INSTRUCTIONS

1. THE PERSONAL EXEMPTIONS ALLOWED ARE:

as dependents. The taxpayer may claim 2 dependents and the spouse 1;

(a) Single individuals - $6,000

or the taxpayer 3 and the spouse none. Enter the amount of dependent

(b) Married individuals (jointly) - $12,000

exemption on line 4.

(d) Dependents - $1,500

(e) An additional exemption of $1,500 may be claimed by either taxpayer

(e) Aged 65 and over - $1,500

or spouse or both if either or both have reached the AGE of 65 before the

(f) Blindness - $1,500

close of the taxable year. No additional exemption is authorized for

dependents by reason of age. Check applicable blocks on Line 5.

2. CLAIMING PERSONAL EXEMPTIONS:

(a) SINGLE INDIVIDUALS enter $6,000 on Line 1.

(f) An additional exemption of $1,500 may be claimed by either taxpayer

or spouse or both if either or both are BLIND. No additional exemption is

(b) MARRIED INDIVIDUALS are allowed a joint exemption of $12,000.

authorized for dependents by reason of blindness. Check applicable

If the spouse is not employed, enter $12,000 on Line 2(a). If the spouse

blocks on Line 5. Multiply number of blocks checked on Line 5 by

is employed, the exemption of $12,000 may be divided between

$1,500 and enter amount of exemption claimed.

taxpayer and spouse in any manner they choose - in multiples of $500. For

example - taxpayer may claim $6,500 and spouse claims $5,500; or

3. TOTAL EXEMPTION CLAIMED:

taxpayer may claim $8,000 andspouse claims $4,000. The total claimed

Add the amount of exemptions claimed in each category and enter the

by taxpayer and spouse may not ex- ceed $12,000. Enter amount claimed

total on Line 6. This amount will be used as a basis for withholding income

by you on Line 2(b).

tax under the appropriate withholding tables.

4. A NEW EXEMPTION CERTIFICATE MUST BE FILED WITH YOUR

is the principal place of abode for himself and at least one dependent.

EMPLOYER WITHIN 30 DAYS AFTER ANY CHANGE IN YOUR

Single individuals qualifying as a head of family enter $9,500 on Line

EXEMPTION STATUS.

3. If the taxpayer has more than one dependent, additional exemptions

are applicable. See item (d).

5. PENALTIES ARE IMPOSED FOR WILLFULLY SUPPLYING FALSE

INFORMATION OR WILLFUL FAILURE TO SUPPLY INFORMATION

(d) An additional exemption of $1,500 may generally be claimed for each

WHICH WOULD REDUCE THE WITHHOLDING EXEMPTION.

dependent of the taxpayer. A dependent is any relative who receives

chief support from the taxpayer and who qualifies as a dependent for

6. IF THE EMPLOYEE FAILS TO FILE AN EXEMPTION CERTIFICATE

Federal income tax purposes. Head of family individuals may claim an

WITH HIS EMPLOYER, INCOME TAX MUST BE WITHHELD BY THE

additional exemption for each dependent excluding the one which is

EMPLOYER ON TOTAL WAGES WITHOUT THE BENEFIT OF

required for head of family status. For example, a head of family tax-

EXEMPTION.

payer has 2 dependent children and his dependent mother living with

him. The taxpayer may claim 2 additional exemptions. Married or single

7. IMPORTANT: USE THIS FORM ONLY FOR PAY PERIODS IN 2000

individuals may claim an additional exemption for each dependent, but

AND AFTER.

should not include themselves or their spouse. Married taxpayers may

divide the number of their dependents between them in any manner

8. To comply with the Military Spouses Residency Relief Act (PL 111-97)

they choose; for example, a married couple has 3 children who qualify

Signed into law November 11, 2009.

Form 89-350-10-2 - Mississippi Employee'S Withholding Exemption Certificate - Department Of Revenue

Related Articles

Related forms

Related Categories