Form OW-9-MSE
Created 1-2010
Oklahoma Tax Commission
Calendar Year:
Annual Withholding Tax Exemption Certification for Military Spouse
Read the instructions before completing this form. Except for signature, you must print.
Employee Name
Employee Social Security Number
Military Servicemember’s Name
Military Servicemember’s Social Security Number
Street Address where you both reside
City, State, Zip
Name of Military Servicemember’s Station
City, State, Zip
Form OW-9MSE is to be used only for Employees claiming exemption from Oklahoma’s Income Tax Withholding
requirements because they meet the conditions set forth under the Servicemembers Civil Relief Act, as amended
by the Military Spouses Residency Relief Act (P.L. 111-97).
In order to qualify you must:
• meet the conditions below; and
• complete this form in full; and
• certify by signing this form that you are not subject to Oklahoma withholding tax because you meet the conditions
set forth below.
Check One
1. I am not a military servicemember ........................................................................... YES
NO
2. My spouse is a military servicemember ................................................................... YES
NO
3. My military servicemember spouse has current military orders
assigning him or her to a military location in Oklahoma .......................................... YES
NO
4. My domicile is a state other than Oklahoma ............................................................ YES
NO
If YES, give name of State of Domicile ____________________________________________________ .
5. Is the state listed above the same State of Domicile as the servicemember .......... YES
NO
If you answered YES to all of the above questions you qualify for exemption from Oklahoma withholding tax.
Under penalties of perjury, I certify that I am not subject to Oklahoma withholding tax because I meet the conditions set
forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act (P.L. 111-97)
(
)
Employee’s Signature
Date
Phone Number
Give the certificate to your Employer. Keep a copy for your records.
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