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FORM NDW-M - Exemption From Withholding for a Qualifying
                         Spouse of a U.S. Armed Forces Servicemember                                  For Calendar Year
NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
SFN 28720 (2-2019)                                                                                                                                    20___

      Employee - See "Instructions for employee" for eligibility requirements and other information.
      Employer - See "Instructions for employer" for the purpose and proper handling of this form.

Part 1 - To be completed by the employee
1. For each of the following statements, indicate whether it is true or false by filling in the appropriate circle.  If any of the
statements are false, you are not eligible for the withholding exemption.
                                                                                                                                                      TRUE FALSE
   a.  I am not a member of the U.S. armed forces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   b.  I am married to an active duty member of the U.S. armed forces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   c.  My military spouse and I are domiciled in a state other than North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . .
   d.  My military spouse's permanent duty station is in North Dakota. . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . .
   e. I am residing and working in North Dakota only because I want to be with my military spouse
        while he or she is stationed in North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. If ALL of the statements in item 1 are true, provide the following information for you (the employee) and your
   military spouse.  All boxes must be filled in to be valid.
Employee         Name (First, MI, Last)                                  Social security number State of domicile (legal residence)
information
                 Street address where currently residing     City                               State ZIP code

Military         Name (First, MI, Last)                                                               Social security number
spouse
information      Military spouse's permanent duty station                Military spouse's state of domicile (legal residence)

3. I declare, under penalty of perjury, that the wages I earn for my services performed in North Dakota are exempt from North
Dakota income tax because I meet the conditions for exemption under the Servicemembers Civil Relief Act (50 U.S.C. 4001),
and the information I provided on this form is accurate to the best of my knowledge and belief.
   Employee's signature                                      Date signed                              Phone number

      ATTACH A COPY OF YOUR DEPENDENT MILITARY ID CARD ISSUED BY THE U.S. DEPT. OF DEFENSE
      Give the completed Form NDW-M with attached copy of military ID card to your employer.
      Notify your employer if you become ineligible for this exemption - see instructions.
      You must complete a new Form NDW-M each year to maintain the exemption - see instructions.

Part 2 - To be completed by the employer
   Note:  An employer shall be held harmless from liability for withholding based on the employee's representations on this form.
   Employer name                                                         Employer identification number (EIN)

   Address                                                   City                               State ZIP code

      See "Instructions for employer" for the proper handling of this form.

                                        PRIVACY ACT NOTIFICATION
In compliance with the Privacy Act of 1974, disclosure of a social security number or Federal Employer Identification Number
(FEIN) on this form is required under N.D.C.C. §§ 57-01-15 and 57-38-56, and will be used for tax reporting, identification,
and administration of North Dakota tax laws. Disclosure is mandatory. Failure to provide the social security number or FEIN
may delay or prevent the processing of this form.

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● Your domicile does not change if
Instructions to the sole purpose of your movement Instructions for
Form NDW-M from one state to another is to reside employer
wherever your servicemember spouse
is permanently stationed.
Purpose of form ● You may elect to use the same state Requirement to withhold
The Servicemembers Civil Relief of domicile as your servicemember North Dakota income tax law requires
Act (50 U.S.C. 4001) provides that, if spouse for state tax purposes for any you to withhold North Dakota income
certain conditions are met, wages that tax year in which you are married tax from wages paid to an employee if
a civilian spouse of an active duty U.S. for any part of the year. This means the employee performs services within
armed forces servicemember receives that, regardless of where you are North Dakota and the wages are subject
for working in the state where the domiciled under the normal rules to federal income tax withholding.
servicemember is stationed are exempt (including North Dakota), you will be
from that state’s income tax. A qualifying treated as being domiciled in the state Form NDW-M exemption
civilian spouse must use Form NDW-M where your servicemember spouse is An exception to the requirement to
to exempt the wages from North Dakota domiciled for state tax purposes. withhold North Dakota income tax
income tax withholding. applies if an employee completes and
Completing Form NDW-M gives to you a Form NDW-M. This
If you meet all of the eligibility exception applies only if you have a
Instructions for requirements for the exemption from Form NDW-M on file for the employee;
employee withholding, fill in the last two digits of it is not enough that the employee is
the calendar year in the upper right-hand eligible for the exemption under the Act.
corner, then fill out Items 1 through 3 of
Eligibility Part 1. Attach a copy of your dependent What you must do
You are eligible for the exemption from military ID card to Form NDW-M, and If an employee gives you a completed
North Dakota income tax withholding give them to your employer. Form NDW-M, do the following:
on wages earned in North Dakota if you 1. Check to see that all items in Part 1
meet all of the following conditions: When the withholding are filled in and a copy of the
● You are a civilian who is married exemption takes effect employee’s dependent military ID
to an active duty U.S. armed forces Form NDW-M takes effect on the later of card is attached. If not, return the
servicemember. (1) the date you give it to your employer form to the employee.
● You and your servicemember spouse or (2) the first payroll period your 2. Fill in Part 2.
maintain a domicile (that is, legal employer is able to put the exemption 3. Keep the original signed
residence) in a state other than North into effect. The exemption does not Form NDW-M and copy of the
Dakota. You do not have to have the apply to wages paid prior to the date military ID card for your records;
same state of domicile. See “Domicile Form NDW-M takes effect. it relieves you of your obligation to
outside North Dakota” below. withhold North Dakota income tax,
● Your servicemember spouse’s Annual renewal and holds you harmless from liability
for the employee’s representations on
permanent duty station is in North Form NDW-M is valid only for the
the form.
Dakota. calendar year for which it is completed.
4. Mail a copy of the completed
● The sole purpose for your presence Provided you are still eligible, you
in North Dakota is to be with your must file a new Form NDW-M for each Form NDW-M and military ID card
to:
servicemember spouse. subsequent year you want to continue
Attn: Withholding Tax Section
the exemption from North Dakota
Office of State Tax Commissioner
Domicile outside North withholding.
Dakota 600 E. Blvd. Ave., Dept. 127
Bismarck, ND 58505-0599
“Domicile” refers to your residence Notification of ineligibility
by law, and is also referred to as your You must notify your employer to begin Alternatively, fax it to the
legal residence. It is the place that the withholding of North Dakota income Withholding Tax Section at
is your permanent home, and is the tax from your wages if you become (701) 328-1942, or email scanned
place to which you always intend to ineligible for the exemption. This would copies to withhold@nd.gov.
return whenever you are absent from occur in any of the following cases:
it. Domicile is based on your intent and
●
actions, which must be consistent. If Divorce from the servicemember.
you are a civilian spouse of an active Death of the servicemember. Questions
●
●
duty U.S. armed forces servicemember, Change in domicile to North Dakota If you have questions about this form,
the Servicemembers Civil Relief Act by either spouse. call the Withholding Tax Section at
●
provides the following exceptions to Change in the servicemember’s (701) 328-1248, or send an email to
these domicile (or legal residence) rules: permanent duty station to a location withhold@nd.gov.
outside North Dakota.

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