Form W-4de - Annual Withholding Tax Exemption Certification For Military Spouse

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State of Delaware
Form W-4DE
Division of Revenue
Annual Withholding Tax Exemption Certification
for Military Spouse
Read the instructions before completing this form. Except for signature you must print.
.
Employee Name
Employee Social Security Number
Military Servicemember Spouse’s Name
Spouse’s Social Security Number
Street address where you both currently reside
City
State
Zip code
Name of Military Servicemember’s Station
City
State
Zip code
FORM W- 4DE is to be used only for Employees claiming exemption from Delaware’s Income Tax Withholding
requirements because they meet the conditions set forth under the Servicemembers Civil Relief Act, as amended
by the Military Spouses Residency Relief Act (P.L. 111-97).
In order to qualify you must complete this form in full, meet all the conditions below and certify that you are not subject to
Delaware withholding tax because you meet these conditions.
My spouse is a military servicemember …….….……………..……….…..... (check one)
YES
NO
I am NOT a military servicemember............................................................ (check one)
YES
NO
My military servicemember spouse has current military orders assigning him or her to a military location near
Delaware…………....................................................................................... (check one)
YES
NO
My domicile is a state other than Delaware ….…....................................… (check one)
YES
NO
If yes, give name of State of Domicile
.
Start Exemption. Check here if you answered “YES” to ALL of the above questions, note the start date here
and sign below;
Terminate Exemption. Check here if the answer to one of four questions above is “NO” to start having
Delaware tax withheld, note the start date here and sign below;
(
)
Employee’s Signature
Date
Phone Number
Employer’s Name
Employer’s Signature
Date
Under penalties of perjury, I certify that I am not subject to Delaware withholding tax because l meet the conditions set
forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act (P.L. 111-97)
Give the certificate to your Employer. Keep a copy for your records.

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