Reset Form
Michigan Department of Treasury (Rev. 12-21), Page 1 
                                                                                                                                          Schedule W 
2021 MICHIGAN Withholding Tax Schedule 
Issued under authority of Public Act 281 of 1967, as amended. 
Type or print in blue or black ink.                                                                                                              Attachment 13 
INSTRUCTIONS:         If you had Michigan income tax withheld in 2021, you must complete a Withholding Tax Schedule (Schedule W) to claim the 
withholding on your Individual Income Tax Return  (MI-1040, line 30). Report military pay in Table 1 and military retirement benefits and taxable railroad 
retirement benefits (both Tier 1 and Tier 2) in Table 2 even if no Michigan tax was withheld. Include your completed Schedule W with Form MI-1040.  
See complete instructions on page 2 of this form. If you need additional space, include another Schedule W. 
1. Filer’s First Name                     M.I.   Last Name                                     2. Filer’s Full Social Security No. (Example: 123-45-6789) 

If a Joint Return, Spouse’s First Name    M.I.   Last Name                                     3. Spouse’s Full Social Security No. (Example: 123-45-6789) 

TABLE 1: MICHIGAN TAX WITHHELD OR MILITARY PAY REPORTED ON W-2, W-2G or CORRECTED W-2 FORMS 
  A                          B                                   C                             D                                                 E 
Enter “X” for:  Employer’s identification number                                Box 1 — Wages, tips,                                      Box 17 — Michigan  
Filer orSpouse       (Example: 38-1234567)           Box c — Employer’s name             other compensation                               income tax withheld 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

Enter Table 1 Subtotal from additional Schedule W forms (if applicable).  ......................................................                              00 

4.      SUBTOTAL.  Enter total of Table 1, column E.  ...............................................................................  4.                     00 

TABLE 2: MICHIGAN TAX WITHHELD OR MILITARY RETIREMENT BENEFITS AND RAILROAD RETIREMENT  
BENEFITS (BOTH TIER 1 AND TIER 2) REPORTED ON 1099 FORMS 
  A                          B                                   C                             D                                                 E 
Enter “X” for:  Payer’s federal identification                                  Taxable pension distribution,                             Michigan income 
Filer orSpouse  number (Example: 38-1234567)                  Payer’s name      misc. income, etc. (see inst.)                            tax withheld 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

                                                                                                                                      00                      00 

Enter Table 2 Subtotal from additional Schedule W forms (if applicable).  ......................................................                              00 

5.      SUBTOTAL.  Enter total of Table 2, column E.  ............................................................................... 5.                      00 

6.      TOTAL.   Add lines 4 and 5. Enter here and carry to MI-1040, line 30.  ............................................  6.                               00 

+ 0000 2021 57 01 27 7 

2021 Schedule W, Page 2 

                                         Instructions for Schedule W 
                                         Withholding Tax Schedule 
Schedule W is designed to report State of Michigan income     Completing the Withholding Tables 
tax withholding. Schedule  W enables us to process your       Lines not listed are explained on the form. 
individual income tax return more efficiently. 
                                                              Complete the withholding tables using information from     
Include the completed Schedule       W with your return. An   your W-2 and 1099 forms, and any other documents that 
attachment number is listed in the upper right corner to help report Michigan tax withheld.  If you need additional space, 
you assemble your forms in the correct order behind your      include another Schedule W. 
Individual Income Tax Return(MI-1040).                        Table 1 Column D:      Enter wages, tips, and other        
If a Schedule W          is not included when required, the   compensation from W-2 forms from which Michigan tax was 
processing of your return will be delayed.  Do not submit     withheld. Exception:  Enter military pay even if no Michigan  
W-2 and/or 1099 forms with your return.                       tax was withheld. 
If you are filing an amended return because you received      Table 2 Column D:   Enter unemployment compensation, 
a corrected W-2 you must complete a Schedule W.          Keep taxable pension from your federal return, and any other    
copies of your W-2s with your tax records for six years       taxable income from any 1099 forms from which Michigan 
and have them available if requested by the Department of     tax was withheld.    Exception: Enter military retirement  
Treasury.                                                     benefits and railroad retirement benefits (both Tier 1 and 
                                                              Tier 2) from 1099-R, RRB-1099 and/or RRB-1099-R forms,  
Michigan Residents.          If you paid income tax to a     
                                                              even if no Michigan tax was withheld. 
governmental unit outside of Michigan, see instructions for 
MI-1040, line 18.                                             Line   6: Total.  Enter total of line 4 from Table 1 and line 5  
                                                              from Table 2. Carry the total to Form MI-1040, line 30. 

+ 0000 2021 57 02 27 5