Michigan W4

Enter Personal Information
Last Name:
First Name:
Middle Initial:
Social Security Number:
Driver's License Number (or state ID):
Date of Birth:
Address:
City:
State:
Zip Code:
Are you a new employee?
Yes - If yes, enter date of hire.
No
Date of Hire:
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 ):
A Michigan income tax liability is not expected this year.
Wages are exempt from withholding. Explain:
Permanent home (domicile) is located in the following Renaissance Zone:
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.