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
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.