Pension Recipient'S Federal Income Tax Withholding Authorization
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1Municipal Employees’ Retirement System of Michigan
1134 Municipal Way • Lansing, MI 48917
800.767.MERS (6377) • Fax: 517.703.9706
Pension Recipient’s Federal Income Tax Withholding Authorization
Please print • Retain a copy for your records
1. Information about you
Last four digits of SSN*
Last name*
First name*
Email address
Phone number (with area code)*
Name of employer*
2. Select pension payment(s)
If you receive MERS pension payments from more than one employer, you may elect to apply the below tax preferences to ALL MERS
pensions or submit separate withholding certificates for each. Exemptions will be applied to each pension independently. If you receive
more than one pension from MERS, please consult with your tax preparer.
Please choose your option:
All (or the only) employer(s) from which I receive a MERS pension payment
Only the employer listed above in Section 1 (any other pension payments will remain unchanged)
3. Federal income tax withholding
This change takes effect the month after MERS receives this form unless you specify a later month: _______________________
Single
Married
Married, but withhold at higher “Single” rate
Marital tax status:
I DO NOT want any federal income tax withheld from my pension. (Proceed to Section 4.)
I DO want federal income tax withheld from my pension. (Complete lines below.)
The total number of exemptions I am claiming to be withheld from each pension payment is listed below.
Total number of exemptions: ___________ (If blank, zero will be used)
Optional additional amount, if any, I want withheld from each pension payment
(If requesting an additional amount, you must enter a number of exemptions above – even if it is zero.): $__________________
For additional instructions, see IRS Form W-4P, Withholding Certificate for Pension or Annuity Payments.
4. Required signature
Employee signature*
Date (mm/dd/yyyy)*
Data collected on this form will be used by MERS staff for identification and documentation only.
* Required field
The Tax Reform Act of 1986 established a requirement that withholding and/or estimated tax payments must approximate 90
percent of your tax liability to escape penalty. Also, the added personal exemption for those age 65 or over has been eliminated.
For these reasons, you may wish to review and possibly change the withholding from your retirement allowance.
If there is not enough federal income tax withheld from your retirement allowance, you may be required to file quarterly estimated
income tax payments or pay a penalty imposed by the Internal Revenue Service. Therefore, if your circumstances have changed,
you should file a new withholding authorization.
If you do not submit this form, MERS must withhold on the basis of Married with 3 exemptions.
Please return a copy of this completed form to:
If you have speech or hearing difficulties and need
assistance completing this form, contact the Michigan
Municipal Employees’ Retirement System of Michigan
Relay Center at 800.649.3777. If you have other
1134 Municipal Way
disabilities, contact MERS at 800.767.MERS (6377) to
Lansing, MI 48917
request special accommodations.
Fax: 517.703.9706
Page 1 of 1
Form F-31 (version 2015-02-19)
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