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MI-W4 (Rev. 12-20) EMPLOYEE’S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE STATE OF MICHIGAN - DEPARTMENT OF TREASURY This certificate is for Michigan income tax withholding purposes only. Read instructions on page 2 before completing this form. Issued under P.A. 281 of 1967. 41. Full Social Security Number 42. Date of Birth 43. Name (First, Middle Initial, Last) 4. Driver’s License Number or State ID Home Address (No., Street, P.O. Box or Rural Route) 45. Are you a new employee? (mm/dd/yyyy) Yes If Yes, enter date of City or Town State ZIP Code No 6. Enter the number of personal and dependent exemptions (see $ .00 7. Additional amount you want deducted from each pay (if employer 8. I claim exemption from withholding because (see instructions): 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: If you fail or refuse to file this form, your employer must withhold Michigan income tax from your wages without allowance for any exemptions. Keep a copy of this form for your records. See additional instructions on page 2. Under penalty of perjury, I certify that the number of withholding exemptions claimed on this certificate does not exceed the number I am allowed to claim. If claiming exemption from withholding, I certify that I do not anticipate a Michigan income tax liability this year. 9. Employee’s Signature 4Date EMPLOYER: Complete the below section. 10. Employer’s Name 411. Federal Employer Identification Number Address (No., Street, P.O. Box or Rural Route) City or Town State ZIP Code Name of Contact Person Contact Phone Number INSTRUCTIONS TO EMPLOYER: Keep a copy of this certificate with your records. All new hires must be reported to the State of Michigan. See www.mi-newhire.com for information. In addition, a copy of this form must be sent to the Michigan Department of Treasury if the employee claims 10 or more exemptions or claims they are exempt from withholding. Send a copy to: Michigan Department of Treasury Tax Technical Section P.O. Box 30477 Lansing, MI 48909 Reset Form ---PAGE BREAK--- INSTRUCTIONS TO EMPLOYEE’S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE (Form MI-W4) You must submit a Michigan withholding exemption certificate (form MI-W4) to your employer on or before the date that employment begins. If you fail or refuse to submit this certificate, your employer must withhold tax from your compensation without allowance for any exemptions. Your employer is required to notify the Michigan Department of Treasury if you have claimed 10 or more personal or dependency exemptions or claimed that you are exempt from withholding. You MUST provide a new MI-W4 to your employer within 10 days if your residency status changes or if your exemptions decrease because: a) your spouse, for whom you have been claiming an exemption, is divorced or legally separated from you or claims his/her own exemption(s) on a separate certificate, or b) a dependent no longer qualifies under the Internal Revenue Code. Line 5: If you check “Yes,” enter your date of hire. Line 6: Personal and dependency exemptions. The number of exemptions claimed here may not exceed the number of exemptions you are entitled to claim on a Michigan Individual Income Tax Return (Form MI-1040). Dependents include qualifying children and qualifying relatives under the Internal Revenue Code, even if your AGI exceeds the limits to claim federal tax credits for them. Do not claim the same exemptions more than once or tax will be under-withheld. Specifically, do not claim: • Your personal exemption if someone else will claim you as their dependent. • Your personal exemption with more than one employer at a time. • Your spouse’s personal exemption if they claim it with their employer. • Your dependency exemptions if someone else (for example, your spouse) is claiming them with their employer. Line 7: You may designate additional withholding if you expect to owe more than the amount withheld. Line 8a: You may claim exemption from Michigan income tax withholding if all of the following conditions are met: Your employment is intermittent, temporary, or less than full time; ii) Your personal and dependency exemptions exceed your annual taxable compensation; iii) You claimed exemption from federal withholding; and iv) You did not incur a Michigan income tax liability for the previous year. Line 8b: Reasons wages might be exempt from withholding include: • You are a nonresident spouse of military personnel stationed in Michigan. • You are a resident of one of the following reciprocal states while working in Michigan: Illinois, Indiana, Kentucky, Minnesota, Ohio, or Wisconsin. • You are a member of a Native American tribe that has a tax agreement with the State of Michigan and whose principal place of residence is within the designated agreement area. • You are an enrolled member of a federally- recognized tribe that does not have a tax agreement with the State of Michigan, you reside within that tribe’s Indian Country (as defined in 18 USC 1151), and compensation from this job will be earned within that Indian Country. Line 8c: For questions about Renaissance Zones, contact your local assessor’s office.