Form Mi-W4 - Employee'S Michigan Withholding Exemption Certificate
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MI-W4
EMPLOYEE'S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE
STATE OF MICHIGAN - DEPARTMENT OF TREASURY
(Rev. 7-03)
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 below before completing this form.
4
4
1. Social Security Number
2. Date of Birth
Issued under P.A. 281 of 1967.
4
3. Type or Print Your First Name, Middle Initial and Last Name
4. Driver License Number
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
4
Enter the number of personal and dependency exemptions you are claiming
6.
6.
Additional amount you want deducted from each pay
7.
$
.00
(if employer agrees)
7.
I claim exemption from withholding because (see instructions):
8.
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: _________________________________
EMPLOYEE:
Under penalty of perjury, I certify that the number of withholding exemptions claimed on this certificate does not
If you fail or refuse to file this form, your
exceed the number to which I am entitled. If claiming exemption from withholding, I certify that I anticipate that I
will not incur a Michigan income tax liability for this year.
employer must withhold Michigan income tax
4
from your wages without allowance for any
9. Employee's Signature
Date
exemptions. Keep a copy of this form for your
records.
Employer: Complete lines 10 and 11 before sending to the Michigan Department of Treasury.
INSTRUCTIONS TO EMPLOYER:
10. Employer's Name, Address, Phone No. and Name of Contact Person
Employers must report all new hires to the State
of Michigan. Keep a copy of this certificate with
your records. If the employee claims more than
4
nine personal and dependency exemptions or
11.
Federal Employer Identification Number
claims a status 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
If you hold more than one job, you may not claim the same
certificate (form MI-W4) to your employer on or before the date
exemptions with more than one employer. If you claim the
that employment begins. If you fail or refuse to submit this
same exemptions at more than one job, your tax will be under
certificate, your employer must withhold tax from your
withheld.
compensation without allowance for any exemptions. Your
employer is required to notify the Michigan Department of
Line 7: You may designate additional withholding if you expect
Treasury if you have claimed more than nine dependency
to owe more than the amount withheld.
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
You MUST file a new MI-W4 within 10 days if your residency
tax liability for the current year because all of the following
status changes or if your exemptions decrease because: a)
your spouse, for whom you have been claiming an exemption,
exist:
a) your employment is less than full time, b) your
is divorced or legally separated from you or claims his/her own
personal and dependency exemption allowance exceeds your
exemption(s) on a separate certificate, or b) a dependent must
annual compensation, c) you claimed exemption from federal
be dropped for federal purposes.
withholding, d) you did not incur a Michigan income tax liability
for the previous year. You may also claim exemption if your
Line 5: If you check "yes," enter your date of hire
permanent home (domicile) is located in a Renaissance Zone.
(mo/day/year).
For more information on Renaissance Zones call the Michigan
Tele-Help System, 1-800-827-4000, and listen to topic 293.
Line 6: Personal and dependency exemptions. The total
Full-time students cannot claim exempt status.
number of exemptions you claim on the MI-W4 may not
exceed the number of exemptions you are entitled to claim
Web Site
when you file your Michigan individual income tax return.
Visit the Treasury Web site 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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