Form W-4me - Maine Employee'S Withholding Allowance Certificate
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1
2MAINE
FORM
W-4ME
Employee’s Withholding Allowance Certifi cate
1.
Type or print your fi rst name
M.I.
Last name
2. Your social security number
-
-
Home address (number and street or rural route)
3.
Single
Married
Married, but withholding at higher single rate
City or town
State
ZIP code
Note: If married but legally separated, or spouse is a nonresident
alien, check the single box
.
4.
Total number of allowances you are claiming from line C of the personal allowances worksheet below ..................... 4.
5.
Additional amount, if any, you want withheld from your paycheck ................................................................................ 5.
$
6.
If you do not want any state income tax withheld, check the appropriate box that applies to you (you must qualify - see instructions below). By
signing below, you certify that you qualify for the exemption that you select:
a.
You claimed “Exempt” on line 7 of your federal Form W-4 .................................................................................................................. 6a.
b.
You completed federal Form W-4P and checked the box on line 1 .................................................................................................... 6b.
c.
You are a resident employee with no Maine tax liability in prior or current year ................................................................................. 6c.
d.
You are a recipient of periodic retirement payments with no tax liability in prior or current year ........................................................ 6d.
e.
Your spouse is a member of the military assigned to a location in Maine and you qualify for exemption under the Military
Spouse’s Residency Relief Act. You must attach supporting documents. See instructions.............................................................. 6e.
Under penalties of perjury, I certify that I am entitled to the number of withholding allowances or the exemption claimed on this certifi cate.
EMPLOYEE’S/PAYEE’S SIGNATURE
(Form is not valid
unless you sign it.)
Date
TO BE COMPLETED BY EMPLOYER/PAYER (see Instructions)
7. Employer/Payer Name and Address
8. Identifi cation Number
(Employer/Payer: Complete lines 7, 8, 9, and 10 only if sending to Maine
Revenue Services)
9. Employer/Payer Contact Person:
10. Contact Person’s Phone Number:
-
(
(
_ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _
Cut here and give the certifi cate above to your employer. Keep the part below for your records.
Personal Allowances Worksheet - for line 4 above
A. Number of allowances claimed on federal Form W-4, line 5 or Form W-4P, line 2. ................................................................A. _________________
B. Less: Number of allowances claimed on federal Form W-4 Personal Allowances Worksheet,
line G for the Child Tax Credit..................................................................................................................................................B. _________________
C. Maximum number of allowances for Maine purposes (line A minus line B). Enter here and on line 4 above. See line 4
instructions below if you want to claim fewer allowances or more allowances than claimed for federal purposes. ................C. _________________
Employee/Payee Instructions
Purpose: Complete Form W-4ME so your employer/payer can withhold the
withheld even though you are exempt from federal withholding.
correct Maine income tax from your pay. Because your tax situation may
Line 6b. You may check this box if you completed federal Form W-4P
change, you may want to recalculate your withholding each year.
and put a check in the box on line 1. Do not check this box if you want
Maine income taxes withheld even though you are exempt from federal
Line 4. If you qualify for one of the Maine exemptions from withholding,
withholding.
please complete lines 1, 2, 3 and 6, and sign the form. Otherwise, complete
Line 6c. You may elect this exemption if you are an employee receiving
the Personal Allowances worksheet above. You may claim fewer allowances
than you are entitled to, but you must obtain special permission from the
wages and you meet both of the following conditions:
State Tax Assessor if you want to claim more allowances than claimed on
1. You had no Maine income tax liability last year , and
your federal Form W-4.
2. You reasonably expect to have no Maine income tax liability this
year.
Box 3. Select the marital status that applies to you. You must select the
same marital status you selected on your federal Form W-4, except that
This exemption will expire at the end of the year and you must complete a
married individuals have the option of withholding at the higher single rate.
new Form W-4ME for next year or you will be subject to Maine withholding
Nonresident aliens are required to check the single box regardless of actual
at the maximum rate.
marital status.
Line 6d. You may elect this exemption if you receive periodic retirement
Line 6. Exemptions from withholding:
payments pursuant to IRC § 3405, you had no Maine income tax liability in
the prior year and you reasonably expect you will have no Maine income tax
Line 6a. You may check this box if you claimed “Exempt” on line 7 of your
liability this year. This election will remain in effect until you complete a new
federal Form W-4. Do not check this box if you want Maine income taxes
Form W-4ME.
instructions continued on next page
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