Form CF-W-4   — EMPLOYEE’S WITHHOLDING CERTIFICATE                                                                                                                                 Revised 12/02/2014
FOR MICHIGAN CITIES LEVYING AN INCOME TAX (See list below)  
1. Print your full name                                                       Social Security No.                            Office, Plant, Dept.              Employee Identification No

2. Address, Number and Street                                       Apartment City, Township or Village where you reside                                       State Postal Code

EMPLOYEE: File this form with your     EMPLOYER      : Keep this certificate with your records. If the          YOUR WITHHOLDING EXEMPTIONS                          Resident City Nonresident City
                                                                                                                                                                     Exemptions    Exemptions
employer. Otherwise your employer must information submitted by the employee is not believed to be true, 
withhold tax for the cities without any allowance  correct and complete, the City Income Tax Department must be 4.  Exemptions for yourself (See cities below) 4
for exemptions.                        advised.                                                                 5.  Exemptions for spouse (See cities below)   5
                                       CHECK BOX IF  CHECK THE BOX THAT INDICATES THE                           6.  Exemptions for your dependent children     6
                        CHECK BOX      YOU ARE A     APPROXIMATE AMOUNT OF TIME WORKING 
MICHIGAN CITIES         IF YOU ARE A  NONRESIDENT    FOR EMPLOYER IN THE CHECKED                                7.  Exemptions for your other dependents       7
LEVYING AN INCOME       RESIDENT OF    AND WORK            NONRESIDENT CITY                                     8.  Total number of exemptions claimed         8
TAX AND THE VALUE 
OF ONE EXEMPTION              A LISTED FOR           UNDER 25%      41%       61%      81%                      Exemptions allowed by city for taxpayer and spouse, if married.
                              CITY     EMPLOYER IN   25%   TO       TO        TO       TO                                    Regular   65 or over at end       Blind Deaf          Permanently 
                                       A LISTED CITY       40%      60%       80%      100%                                  exemption of year                                     Disabled
Albion                                                                                                          4. Taxpayer
$600                                                                                                            5.  Spouse
Battle Creek                                                                                                    4. Taxpayer
$750                                                                                                            5. Spouse
Big Rapids                                                                                                      4. Taxpayer
$600                                                                                                            5. Spouse
Detroit                                                                                                         4. Taxpayer
$600                                                                                                            5. Spouse
Flint                                                                                                           4. Taxpayer
$600                                                                                                            5. Spouse
Grand Rapids                                                                                                    4. Taxpayer
$600                                                                                                            5. Spouse
Grayling                                                                                                        4. Taxpayer
$3,000                                                                                                          5. Spouse
Hamtramck                                                                                                       4. Taxpayer
$600                                                                                                            5. Spouse
Highland Park                                                                                                   4. Taxpayer
$600                                                                                                            5. Spouse
Hudson                                                                                                          4. Taxpayer
$1,000                                                                                                          5. Spouse
Ionia                                                                                                           4. Taxpayer
$700                                                                                                            5. Spouse
Jackson                                                                                                         4. Taxpayer
$600                                                                                                            5. Spouse
Lansing                                                                                                         4. Taxpayer
$600                                                                                                            5. Spouse
Lapeer                                                                                                          4. Taxpayer
$600                                                                                                            5. Spouse
Muskegon                                                                                                        4. Taxpayer
$600                                                                                                            5. Spouse
Muskegon Heights                                                                                                4. Taxpayer
$600                                                                                                            5. Spouse
Pontiac                                                                                                         4. Taxpayer
$600                                                                                                            5. Spouse
Port Huron                                                                                                      4. Taxpayer
$600                                                                                                            5. Spouse
Portland                                                                                                        4. Taxpayer
$1,000                                                                                                          5. Spouse
Saginaw                                                                                                         4. Taxpayer
$750                                                                                                            5. Spouse
Springfield                                                                                                     4. Taxpayer
$750                                                                                                            5. Spouse
Walker                                                                                                          4. Taxpayer
$600                                                                                                            5. Spouse
I am not a resident                                                 9. Date                                     10. Signature
of any listed city
I do not expect to 
work in any city listed