Mi-W4 370050 7

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MI-W4 EMPLOYEE'S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE

(Rev. 08-11) STATE OF MICHIGAN - DEPARTMENT OF TREASURY
This certificate is for Michigan income tax withholding purposes only. You must file a revised form within 10 days if your exemptions decrease or your residency status changes
from nonresident to resident. Read instructions below before completing this form.
1. Social Security Number 2. Date of Birth
Issued under P.A. 281 of 1967.
3. Type or Print Your First Name, Middle Initial and Last Name 4. Driver's License Number or State ID
Home Address (No., Street, P.O. Box or Rural Route) 5. Are you a new employee?
Yes If Yes, enter date of hire . . . .
City or Town State ZIP Code
No
6. Enter the number of personal and dependent exemptions you are claiming  6.
7. Additional amount you want deducted from each pay
(if employer agrees) 7. $ .00
8. I claim exemption from withholding because (does not apply to nonresident members of flow-through entities - 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: Under penalty of perjury, I certify that the number of withholding exemptions claimed on this certificate does not
If you fail or refuse to file this form, your exceed the number to which I am entitled. If claiming exemption from withholding, I certify that I anticipate that I
employer must withhold Michigan income tax will not incur a Michigan income tax liability for this year.
from your wages without allowance for any 9. Employee's Signature Date
exemptions. Keep a copy of this form for your
records.
INSTRUCTIONS TO EMPLOYER: Employer: Complete lines 10 and 11 before sending to the Michigan Department of Treasury.
Employers must report all new hires to the State 10. Employer's Name, Address, Phone No. and Name of Contact Person
of Michigan. Keep a copy of this certificate with
your records. If the employee claims 10 or more
personal and dependent exemptions or claims a
status exempting the employee from
withholding, you must file their original MI-W4 11. Federal Employer Identification Number
form with the Michigan Department of Treasury.
Mail to: New Hire Operations Center, P.O. Box
85010; Lansing, MI 48908-5010.
INSTRUCTIONS TO EMPLOYEE
You must submit a Michigan withholding exemption If you hold more than one job, you may not claim the same
certificate (form MI-W4) to your employer on or before the date exemptions with more than one employer. If you claim the
that employment begins. If you fail or refuse to submit this same exemptions at more than one job, your tax will be under
certificate, your employer must withhold tax from your withheld.
compensation without allowance for any exemptions. Your
employer is required to notify the Michigan Department of
Line 7: You may designate additional withholding if you expect
Treasury if you have claimed 10 or more personal and
to owe more than the amount withheld.
dependent exemptions or claimed a status which exempts you
from withholding.
Line 8: You may claim exemption from Michigan income tax
You MUST file a new MI-W4 within 10 days if your residency withholding ONLY if you do not anticipate a Michigan income
status changes or if your exemptions decrease because: a) tax liability for the current year because all of the following
your spouse, for whom you have been claiming an exemption, exist: a) your employment is less than full time, b) your
is divorced or legally separated from you or claims his/her own personal and dependent exemption allowance exceeds your
exemption(s) on a separate certificate, or b) a dependent must annual compensation, c) you claimed exemption from federal
be dropped for federal purposes. withholding, d) you did not incur a Michigan income tax liability
for the previous year. You may also claim exemption if your
Line 5: If you check "Yes," enter your date of hire
permanent home (domicile) is located in a Renaissance Zone
(mo/day/year).
or you are a non-resident spouse of military personnel
Line 6: Personal and dependent exemptions. The total number stationed in Michigan. Members of flow-through entities may
of exemptions you claim on the MI-W4 may not exceed the not claim exemption from nonresident flow-through
number of exemptions you are entitled to claim when you file withholding. For more information on Renaissance Zones call
your Michigan individual income tax return. (517) 636-4486. Full-time students that do not satisfy all of the
above requirements cannot claim exempt status.
If you are married and you and your spouse are both
employed, you both may not claim the same exemptions with Visit the Treasury Web site at: www.michigan.gov/taxes
each of your employers.

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MI-W4 EMPLOYEE'S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE

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