MI-W4

EMPLOYEE’S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE STATE OF MICHIGAN - DEPARTMENT OF TREASURY

This is Certificate is for michigan incom tax withholding purposes only. Read instructions on page 2 before completing this form.
Issued under P.A. 281 of 1967

Full Social Security Number(Required)

Date of Birth(Required)

Full Name(First,Middle Initial,Last)(Required)

Driver’s License Number or State ID(Required)

Are you a new employee?(Required)

YES

If Yes, enter date of hire....(Required)

Home Address (No., Street, P.O. Box or Rural Route)(Required)

City or Town(Required)

State(Required)

ZIP Code(Required)

Enter the number of personal and dependent exemptions (see instructions)

Additional amount you want deducted from each pay (if employer agrees)

I claim exemption from withholding because (see instructions):

Michigan income tax liability is not expected this year

Wages are exempt from withholding.

Permanent home is located in the following Renaissance Zone

Wages are exempt from withholding, explain:

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 do not anticipate a Michigan income tax ability this year.

Employee’s Signature(Required)

Date(Required)

MI-W4

EMPLOYEE’S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE STATE OF MICHIGAN - DEPARTMENT OF TREASURY

EMPLOYEE :

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