Form W-4 (Form Mw 507) - Employee Withholding Allowance Certificate - Maryland State Government Employees Only - 2014
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1Employee Withholding Allowance Certificate
Employee Withholding Allowance Certificate
2014
2014
2007
FOR MA
FOR MARYLAND S
AND STATE G
TE GOVERNM
RNMENT T EMP
MPLOYEES ONLY
S ONLY
Form W-4 -4
Form MW 507
orm MW 507
Depa
Department of the
tment of the Treasu
easury
Compt
Comptroller of Ma
oller of Maryland
land
Internal R
Internal Revenue
venue Service
vice
Please c
lease complete form in bla
mplete form in black ink
k ink. Whether
hether you a
ou are entitled to
e entitled to claim a ce
laim a certain number of all
tain number of allowances or exempti
wances or exemption f
n from withholding is
om withholding is
subject to
subject to revi view by the I
w by the IRS. Your empl
our employer may be
er may be requi
equired to send a copy of this form to the I
ed to send a copy of this form to the IRS.
S S ection 1 - Empl
ection 1 - Employee Info
yee Information
mation
Payroll oll System (check one)
stem (check one)
Name of Empl
ame of Employing Agen
ing Agency
CT
CT
UM
RG
Social
ocial Secu
ecurity y Number
umber
Empl
Employee
yee Name
ame
Agen
Agency y Number
umber
Add ddress Continued (apa
ess Continued (apartment numbe
tment number, if any)
if any)
Home
Home Add ddress (number and st
ess (number and street or
eet or rural
ural route)
oute)
County of Residence (required)
County of Residence (required)
State
State
Zip Code
Zip Code
City
City
S S ection 2 -
ection 2 - Federal
ederal Withholding
ithholding Form W-4 -4
The federal wo
The federal worksheet is available online at
ksheet is available online at w.irs.g
.irs.gov/pub/irs-pdf/fw4.pdf
v/pub/irs-pdf/fw4.pdf
4 If
4 If your last name differs f
our last name differs from that shown on
om that shown on your social secu
our social security y card
ard,
3 Single
ingle
Mar
Married
ied
Mar
Married
ied, but withhold at higher
but withhold at higher Single Rate
ingle Rate
che
check here
k here. You ou must
ust call 1-800-772-1213 for a replacement
all 1-800-772-1213 for a replacement card.
ard.
Note
ote. If mar
If married
ied, but legal
but legally separated
y separated, or spouse is a non
or spouse is a nonresident alien
esident alien, che
check the
k the “Singl
ingle” b box.
5
5
Total number of all
otal number of allowances
wances you a
ou are e claiming (f
laiming (from page 1 or page 2 of the federal wo
om page 1 or page 2 of the federal worksheet)
ksheet)
6
$
6
Additional amount
dditional amount, if an
if any, you want withheld f
ou want withheld from each pa
om each payche heck .....................................................................................
k .....................................................................................
7 I I claim exemption f
laim exemption from withholding for 2014
om withholding for 2014, and I ce
and I certify that I meet
tify that I meet both
both of the foll
of the following conditions for exemption.
wing conditions for exemption.
• Last year I had a right to a refund of
• Last year I had a right to a refund of all all federal income tax withheld because I had
federal income tax withheld because I had no
no tax liability
tax liability and
and
• This year I expect a refund of
• This year I expect a refund of all all federal income tax withheld because I expect to have
federal income tax withheld because I expect to have no
no tax liability
tax liability
7
If If you meet both conditi
ou meet both conditions ns, write ite “Exemp
Exempt” he here.........................................................................
e.........................................................................
Section 3 - Ma
ection 3 - Maryland
land Withholding
ithholding Form MW 507
m MW 507
The Ma
The Maryland wo
land worksheet is available online at
ksheet is available online at
ent_forms/MW507.pdf
Withhold at Single Rate
Withhold at Single Rate
Married (surviving spouse or unmarried Head of Household) Rate
Married (surviving spouse or unmarried Head of Household) Rate
Married, but withhold at Single Rate
Married, but withhold at Single Rate
1 1 . Total number of exemptions
otal number of exemptions you a
ou are e claiming not to exceed line f in Personal Exemption Worksheet on page 2. . .
laiming not to exceed line f in Personal Exemption Worksheet on page 2. . .
1.________________
1.________________
2. Additional withholding per pay pe
dditional withholding per pay period under ag
iod under agreement with empl
eement with employer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
yer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.________________
2.________________
3. I I claim exemption f
laim exemption fro rom withholding be
m withholding because I do not expect to
ause I do not expect to owe Ma
we Maryland tax
land tax. See instructions below and check boxes that apply.
See instructions below and check boxes that apply.
a. Last year I did not
ast year I did not owe any Ma
we any Maryland income tax and had a
land income tax and had a right to a full
ight to a full refund of all income tax withheld and
efund of all income tax withheld and
b b. This year I do not expect to
This year I do not expect to owe any Ma
we any Maryland income tax and expect to have the
land income tax and expect to have the right to a full
ight to a full refund of all income tax withheld
efund of all income tax withheld.
( (This in
This includes seasonal and student empl
ludes seasonal and student employees whose annual income wi
ees whose annual income will be bel
l be below the mini
w the minimum filing
um filing requi
equirements)
ements).
If both a and b app
If both a and b apply, enter year appli
enter year applicable _______ (year effective) Enter
able _______ (year effective) Enter “EXEMPT
PT” he here. . . . . . . . . . . . . .
e. . . . . . . . . . . . . .
3.________________
3.________________
4. I I claim exemption f
laim exemption fro rom withholding be
m withholding because I am domiciled in one of the foll
ause I am domiciled in one of the following states
wing states. Che
Check state that applies.
k state that applies.
Virginia
irginia
I fu
I further ce
ther certify that I do not maintain a place of abode in Ma
tify that I do not maintain a place of abode in Maryland as desc
land as described in the inst
ibed in the instructi
uctions above.
ns above.
Enter
Enter “EXEMPT” he here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.________________
4.________________
5. 5. I claim exemption from Maryland
I claim exemption from Maryland state
state withholding because I am domiciled in the Commonwealth of Pennsylvania
withholding because I am domiciled in the Commonwealth of Pennsylvania
and I do not maintain a place of abode in Maryland as described in the instructions on Form MW507.
and I do not maintain a place of abode in Maryland as described in the instructions on Form MW507.
Enter “EXEMPT” here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter “EXEMPT” here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. I claim exemption from Maryland
6. I claim exemption from Maryland local
local tax because I live in a local Pennysylvania jurisdiction within York or
tax because I live in a local Pennysylvania jurisdiction within York or
Adams counties. Enter “EXEMPT” here and on line 4 of Form MW507. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adams counties. Enter “EXEMPT” here and on line 4 of Form MW507. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.________________
6.________________
7. I claim exemption from Maryland
7. I claim exemption from Maryland local
local tax because I live in a local Pennsylvania jurisdiction that does not impose
tax because I live in a local Pennsylvania jurisdiction that does not impose
an earnings or income tax on Maryland residents. Enter “EXEMPT” here and on line 4 of Form MW507. . . . . .
an earnings or income tax on Maryland residents. Enter “EXEMPT” here and on line 4 of Form MW507. . . . . .
7.________________
7.________________
8. I certify that I am a legal resident of the state of ____________ and am not subject to Maryland withholding because
8. I certify that I am a legal resident of the state of ____________ and am not subject to Maryland withholding because
l meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses
l meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses
Residency Relief Act. Enter “EXEMPT” here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Residency Relief Act. Enter “EXEMPT” here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.________________
8.________________
Section 4 - Employee
ection 4 - Employee Signature
nature
Under penalties of perju
Under penalties of perjury, I de
I decla lare that I have examined this ce
e that I have examined this certifi
tificate and to the best of my kn
ate and to the best of my knowledge and belie
wledge and belief, it is t
it is true, cor
correct
ect, and complete
and complete. I I
fu further ce
ther certify that I am entitled to the number of withholding all
tify that I am entitled to the number of withholding allowances
wances claimed on line 1 ab
laimed on line 1 above, or if
or if claiming exemption fr
laiming exemption from withholdin
om withholding, that I am
that I am
entitled to
entitled to claim the exempt status on which
laim the exempt status on whicheverline(s) I completed.
verline(s) I completed.
Empl
Employe yee’s si
s signature
nature
Date_________________________
Date_________________________
(Form is not valid
orm is not valid unless
unless you sign it.) __________________________________________________________________
ou sign it.) __________________________________________________________________
Employer’s name and address (including zip code) (For employer use only)
Employer’s name and address (including zip code) (For employer use only)
Federal Employer identification number
Federal Employer identification number
Central Payroll Bureau
Central Payroll Bureau
52-6002033
52-6002033
P.O. Box 2396
P.O. Box 2396
(For State of Maryland - CPB use only)
(For State of Maryland - CPB use only)
Annapolis, MD 21404
Annapolis, MD 21404
Impo
Important
tant: The info
e informa
mation
ion you supp
ou supply y must be complete
ust be complete. This fo
is form wi
m will replace in total a
l replace in total any ce
y certifi ificate
ate you pr
ou previous
viously submit
y submit ted.
ted.
Web eb Site -
ite - omp.state.md.us/cpb
.state.md.us/cpb
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