Form Sc W-4 - Annual Withholding Certification For Military Servicemember'S Nonresident Spouse

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STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
SC W-4
(Rev. 5/26/10)
ANNUAL WITHHOLDING CERTIFICATION FOR MILITARY
3527
SERVICEMEMBER'S NONRESIDENT SPOUSE
Employee’s Name
Spouse’s (Military Servicemember’s) Name
Employee’s Social Security Number
Spouse’s Social Security Number
Street Address Where You and Your Spouse
Name of Spouse’s Military Station
Are Currently Living
City, State and ZIP Where You Are Living
Physical Address of Military Station
Home Telephone Number
City, State and ZIP of Military Station
Complete Questions 1 through 3a. A “NO” answer to any of these questions means that you are not exempt from
withholding under the Military Spouses Residency Relief Act:
1a.
Is your spouse a servicemember who is present in South Carolina or a bordering state in compliance with military
orders?
YES
NO
b.
What is the name of the bordering state, if applicable?
2.
Are you in South Carolina or the bordering state solely to be with your spouse?
YES
NO
3a.
Do you and your spouse maintain the same domicile in a state other than South Carolina (and the bordering state,
if applicable)?
YES
NO
b.
What is your state of domicile?
Sign below if you answered “YES” to Questions 1a, 2, and 3a.
Signature
Date
I declare that this return and all attachments are true, correct and complete to the best of my knowledge and belief. To
wilfully furnish a false or fraudulent statement to the Department is a crime.
EMPLOYEE: Give the original SC W-4 to your employer and keep a copy for your records.
NOTE: This form is only valid for ONE calendar year. In order to maintain the exemption, an employee must
complete a new SC W-4 in the last quarter before the start of the new calendar year.
35271014

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