Form Mi-W4 - Employee'S Michigan Withholding Exemption Certificate - Department Of Treasury - 2002
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EMPLOYEE'S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE
STATE OF MICHIGAN - DEPARTMENT OF TREASURY
(Rev. 6/02)
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 below before completing this form.
4
4
1. Social Security Number
2. Date of Birth
Issued under P.A. 281 of 1967. Filing is mandatory.
4
3.
4. Driver License Number
Type or Print Your First Name, Middle Initial and Last Name
4
Home Address (No., Street, P.O. Box or Rural Route)
5.
Are you a new employee?
Yes
If yes, enter date of hire . . . .
City or Town
State
ZIP Code
No
6.
Enter the number of personal and dependency exemptions you are claiming
4
6.
7.
Additional amount you want deducted from each pay
(if employer agrees)
$
.00
7.
8.
I claim exemption from withholding because (see instructions):
a.
A Michigan income tax liability is not expected this year.
b.
Wages are exempt from withholding. Explain: _______________________________________________________
c.
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
EMPLOYEE:
exceed the number to which I am entitled. If claiming exemption from withholding, I certify that I anticipate that I
If you fail or refuse to file this form, your
will not incur a Michigan income tax liability for this year.
employer must withhold Michigan income tax
4
Date
9.
from your wages without allowance for any
Employee's Signature
exemptions. Keep a copy of this form for your
records.
INSTRUCTIONS TO EMPLOYER:
Employer: Complete lines 10 and 11 before sending to the Michigan Department of Treasury.
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
4
11.
Federal Employer Identification Number
exempting the employee from withholding, you
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.
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