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MI-W4 
(Rev. 12-20) 

EMPLOYEE’S MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE 
STATE OF MICHIGAN - DEPARTMENT OF TREASURY 
This certificate is for Michigan income tax withholding purposes only. Read instructions on page 2 before completing this form. 
Issued under P.A. 281 of 1967.                                                  41. Full Social Security Number                                42. Date of Birth 

43. Name (First, Middle Initial, Last)                                          4. Driver’s License Number or State ID 

Home Address (No., Street, P.O. Box or Rural Route)                             45. Are you a new employee?                                           (mm/dd/yyyy) 
                                                                                 Yes          If Yes, enter date of hire........ 
City or Town                                        State              ZIP Code 
                                                                                 No 

6. Enter the number of personal and dependent exemptions (see instructions)     ...........................................................46. 

7. Additional amount you want deducted from each pay (if employer agrees)       ...................................................................7. $                     .00

8.  I claim exemption from withholding because (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: 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 I do not anticipate a Michigan income tax liability this year. 
9. Employee’s Signature                                                                                                                        4Date 

EMPLOYER: Complete the below section. 
10. Employer’s Name                                                             411. Federal Employer Identification Number 

Address (No., Street, P.O. Box or Rural Route)                                  City or Town                                                          State        ZIP Code 

Name of Contact Person                                                          Contact Phone Number 

INSTRUCTIONS TO EMPLOYER: Keep a copy of this certificate with your records. All new hires must be reported to the State of Michigan. See  
www.mi-newhire.com for information. 
In addition, a copy of this form must be sent to the Michigan Department of Treasury if the employee claims 10 or more exemptions or claims they are 
exempt from withholding. Send a copy to: 
         Michigan Department of Treasury  
         Tax Technical Section  
         P.O. Box 30477 
         Lansing, MI 48909 

                                INSTRUCTIONS TO  EMPLOYEE’S   
        MICHIGAN WITHHOLDING EXEMPTION CERTIFICATE (Form MI-W4) 

You  must  submit  a  Michigan  withholding  exemption          Line   7:   You may designate additional withholding if  you 
certificate (form  MI-W4) to your  employer  on or before       expect to owe more than the amount withheld. 
the  date  that  employment  begins.  If  you  fail  or  refuse 
                                                                Line 8a: You may claim exemption from Michigan income 
to  submit  this  certificate,  your  employer must  withhold 
                                                                tax withholding if all of the following conditions are met: 
tax  from your  compensation  without  allowance for  any 
exemptions. Your employer is required to notify the                i)    Your employment is intermittent, temporary, or less 
Michigan Department of Treasury if you have claimed 10                   than full time; 
or more personal or dependency exemptions or claimed 
                                                                   ii)    Your personal and dependency exemptions exceed 
that you are exempt from withholding. 
                                                                         your annual taxable compensation; 
You  MUST  provide  a  new  MI-W4  to  your  employer 
                                                                    iii)   You claimed exemption from federal withholding; 
within  10  days  if  your  residency  status  changes  or  if 
                                                                         and 
your exemptions decrease because: a) your spouse, for 
whom you have been claiming an exemption, is divorced              iv)   You did not incur a Michigan income tax liability for 
or legally separated from you or claims his/her own                      the previous year. 
exemption(s) on a separate certificate, or b) a dependent 
                                                                Line 8b: Reasons wages might be exempt from 
no longer qualifies under the Internal Revenue Code. 
                                                                withholding include: 
Line 5: If you check “Yes,” enter your date of hire. 
                                                                  •    You are a nonresident spouse of military personnel 
Line 6: Personal and dependency exemptions. The                          stationed in Michigan. 
number of  exemptions claimed here may not  exceed 
                                                                  •    You are a resident of one of the following reciprocal 
the number of exemptions you are entitled to claim on a 
                                                                         states while working in Michigan: Illinois, Indiana, 
Michigan  Individual  Income  Tax  Return (Form MI-1040).  
                                                                         Kentucky, Minnesota, Ohio, or Wisconsin. 
Dependents include qualifying children and qualifying  
relatives under the Internal Revenue Code, even if your           •    You are an enrolled member of a federally-
AGI exceeds the limits to claim federal tax credits for                  recognized tribe that does not have a tax 
them.                                                                    agreement with the state of Michigan, you reside 
                                                                         within that  tribe’s Indian Country (as defined in 18 
Do not claim the same exemptions more than once or tax 
                                                                         USC 1151), and compensation from this job will be 
will be under-withheld.  Specifically, do not claim: 
                                                                         earned within that Indian Country. 
  •    Your personal exemption if someone else will claim 
                                                                Line   8c:   For  questions  about  Renaissance  Zones, 
     you as their dependent. 
                                                                contact your local assessor’s office. 
  •    Your  personal exemption with more than one 
     employer at a time. 
  •    Your  spouse’s  personal  exemption  if  they  claim  it 
     with their employer.   
  •    Your dependency  exemptions if  someone else (for 
     example,  your  spouse)  is  claiming  them  with  their 
     employer.