Form Mo W-4 - Employee'S Withholding Allowance Certificate
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Missouri Department of Revenue
Form
Employee’s Withholding Allowance Certificate
MO W-4
This certificate is for income tax withholding and child support enforcement purposes only. Type or print.
Full Name
Social Security Number
Filing Status
r
r
r
Single
Married
Head of Household
Home Address (Number and Street or Rural Route)
City or Town
State
ZIP Code
1. Allowance For Yourself: Enter 1 for yourself if your filing status is single, married, or head of household. ........................ 1
2. Allowance For Your Spouse: Does your spouse work? r Yes r No If yes, enter 0. If no, enter 1 for your spouse .... 2
3. Allowance For Dependents: Enter the number of dependents you will claim on your tax return. Do not claim yourself
or your spouse or dependents that your spouse has already claimed on his or her Form MO W-4. ................................... 3
4. Additional Allowances: You may claim additional allowances if you itemize your deductions or have other state tax
deductions or credits that lower your tax. Enter the number of additional allowances you would like to claim. ................. 4
5. Total Number Of Allowances You Are Claiming: Add Lines 1 through 4 and enter total here. ........................................... 5
6. Additional Withholding: If you expect to have a balance due (as a result of interest income, dividends, income from a
part-time job, etc.) on your tax return, you may request your employer to withhold an additional amount of tax from
each pay period. To calculate the amount needed, divide the amount of the expected balance due by the number of
pay periods in a year. Enter the additional amount to be withheld each pay period here. .................................................. 6
$
7. Exempt Status: If you had a right to a refund of all of your Missouri income tax withheld last year because you had no
tax liability and this year you expect a refund of all Missouri income tax withheld because you expect to have no tax
liability, write “Exempt” on Line 7. See information below. .................................................................................................. 7
8. If you meet the conditions set forth under the Servicemember Civil Relief Act, as amended by the Military Spouses
Residency Relief Act and have no Missouri tax liability, write “Exempt” on line 8. See information below. ...................... 8
9. If income earned as a member of any active duty component of the Armed Forces of the United State is eligible for the
military income deduction write “exempt” on Line 9 .............................................................................................................. 9
Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate, or I am entitled to claim exempt status.
Employee’s Signature (Form is not valid unless you sign it)
Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Employer’s Name
Employer’s Address
Maryville University
650 Maryville University Drive
City
State
ZIP Code
St. Louis
Missouri
63141
Date Services for Pay First Performed by Employee (MM/DD/YYYY)
Federal Employer I.D. Number
Missouri Tax Identification Number
4
3
0
6
5
3
3
6
9
1 0
8
4
9
9
2
1
__ __ / __ __ / __ __ __ __
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Notice To Employer: Within 20 days of hiring a new employee, send a copy of Form MO W-4 to the Missouri Department of Revenue, P.O. Box 3340,
Jefferson City, MO 65105-3340 or fax to (573) 526-8079.
Employee Information — You Do Not Pay Missouri Income Tax on all of the Income You Earn!
Visit
to try our online withholding calculator.
Form MO W-4 is completed so you can have as much “take-home pay” as possible without an income tax liability due to the state of Missouri
when you file your return. Deductions and exemptions reduce the amount of your taxable income. If your income is less than the total of your personal
exemption plus your standard deduction, you should mark “Exempt” on Line 7 above. The following amounts of your annual Missouri adjusted gross
income will not be taxed by the state of Missouri when you file your individual income tax return.
Single
Married Filing Combined
Head of Household
$2,100 — personal exemption
$ 4,200 — personal exemption
$ 3,500 — personal exemption
$6,350 — standard deduction
$12,700 — standard deduction
$ 9,350 — standard deduction
$8,450 — Total
$16,900 — Combined Total (For both spouses)
$12,850 — Total
+ $1,200 for each dependent
+ $1,200 for each dependent
+ $1,200 for each dependent
+ up to $5,000 for federal tax
+ up to $10,000 for federal tax
+ up to $5,000 for federal tax
Items to Remember:
• I f your filing status is married filing combined and your spouse works, do not
• If you are claiming an “Exempt” status due to the Military Spouses Residency
claim an exemption on Form MO W-4 for your spouse.
Relief Act you must provide one of the following to your employer: Leave
• I f you and your spouse have dependents, please be sure only one of you claim
and Earnings Statement of the non-resident military servicemember, Form
W-2 issued to the nonresident military servicemember, a military identification
the dependents on your Form MO W-4. If both spouses claim the dependents
card, or specific military orders received by the servicemember. You must
as an allowance on Form MO W-4, it may cause you to owe additional Missouri
also provide verification of residency such as a copy of your state income tax
income tax when you file your return.
return filed in your state of residence, a property tax receipt from the state of
• I f you have more than one employer, you should claim a smaller number or no
residence, a current drivers license, vehicle registration or voter ID card.
allowances on each Form MO W-4 filed with employers other than your princi-
pal employer so the amount withheld will be closer to your amount of total tax.
• I f you itemize your deductions, instead of using the standard deduction, the
amount not taxed by Missouri may be a greater or lesser amount.
Form MO W-4 (Revised 12-2016)
Mail to:
Taxation Division
Phone: (573) 751-8750
Visit
P.O. Box 3340
Fax: (573) 526-8079
Jefferson City, MO 65105-3340
for additional information regarding new hire reporting.
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