Michigan Department of Treasury - City Tax Administration                                                                                                             Reset Form
5527 (01-18)

Employee’s Withholding Exemption Certificate for the City of Detroit (DW-4)
Issued under authority of Public Act 284 of 1964, as amended.                  Withholding Tax is for the City of                                 City Code
                                                                               DETROIT                                                            170
Employee’s Full Name                                                                                                                              Social Security Number

Address                                                                                                                                           Employee Identification Number

City, Township, or Village where you reside                                    State                      ZIP/Postal Code                         Office, Plant, Dept.

 In the fields below, enter the name of each city where you work for this employer and check (x) the closest percentage of total earnings in each.
City                                                                                                                                                   Renaissance Zone Exemption
                                                                         Under 25%                 41%    61%                                     81%- 
                                                                         25%   -40%                -60%   -80%                                    100%
City                                                                                                                                                   Renaissance Zone Exemption
                                                                         Under 25%                 41%    61%                                     81%- 
                                                                         25%   -40%                -60%   -80%                                    100%

In the fields below, enter exemptions for the employee, the employee’s spouse, and other dependents. Total the exemptions in the right column.
Exemptions for employee.           Regular                               Additional exemption if          Additional                                   Total exemptions 
(Check all that apply.) .......... exemption                             65 or over at end of year        exemption if blind                           for employee ....................

Exemptions for spouse.             Regular                               Additional exemption if          Additional                                   Total exemptions for 
(Check all that apply.) .......... exemption                             65 or over at end of year        exemption if blind                           employee’s spouse ..........

Exemptions for children.                                                 Exemptions for other dependents.                                              Total exemptions 
(Enter number at right.) ............................................... (Enter number at right.) ...............................................      for children/others ............

Total exemptions claimed by this employee. Add all exemptions from the right column .......................................................................................................................

CERTIFICATION

I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
Employee Signature                                                                                                                                     Date

EmplOyEE: File this form with your employer. Otherwise, your employer must withhold City of Detroit income tax from your earnings 
without exemption.
EmplOyER: Keep this certificate with your records. Advise the City Tax Administration if the information submitted by the employee is 
not believed to be true, correct and complete.
                                                                         INsTRuCTIONs
City where you work for this employer: If working for this employer in more than two cities or communities, print the names of the two 
Michigan cities or communities where performing the greatest percentage of your work. Check (X) the closest percent of total earnings 
for work done or services rendered in each city or community listed. The estimated percent of total earnings from this employer for work 
done or services performed within taxing cities is for withholding purposes only. This estimate is subject to substantiation and audit when 
determining final tax liability.
Renaissance Zone Exemption: Attach copy of the Certification of Qualification.
Exemptions: You are allowed the same number of exemptions for yourself and dependents as for federal income tax purposes, except 
that additional withholding allowances claimed on Schedule A of Federal Form W-4 are not allowed for City of Detroit income tax 
purposes.
Changes in Exemptions: You should file a new certificate with your employer any time the number of your exemptions changes.
Change of Residence: You must file a new certificate within 10 days after changing residence from or to a taxing city.
Changes in Employment: You must file a new certificate by December 1 of each year if the estimate of the percent of work done or 
services to be rendered in cities levying an income tax will change for the ensuing year.

                                                                         www.michigan.gov/citytax