W-4MN, Minnesota Employee Withholding Allowance/Exemption Certificate

2023 W-4MN, Minnesota Employee Withholding Allowance/Exemption Certificate
Employees
Complete Form W-4MN so that your employer can withhold the correct Minnesota income tax from your pay. Consider completing a new Form W-4MN each or and when your personal or financial situation changes.
Employee’s First Name and Middle Initial
Last Name
Email address
example@example.com
Employee’s Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status (Check one)

Single; Married, but legally separated; or Spouse is a nonresident alienMarriedMarried, but withhold at higher Single rate
Read instructions on back (download 2023 W-4MN for this information if needed). Complete Section 1 OR Section 2, then sign and give the completed form to your employer. Do not complete both Section 1 and Section 2. Completing both sections will make the form invalid.
Section 1 — Determining Minnesota Allowances
A Enter “1” if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A
B Enter “1” if any of the following apply: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
- You are single and have only one job
- You are married, have only one job, and your spouse does not work
- Your wages from a second job or your spouse’s wages are $1500 or less
C Enter "1" if you are married. You may choose to enter "0" if you are married and have either a working spouse or more than one job. (Entering “0” may help you avoid having too little tax withheld) . . . . . C
D Enter the number of dependents (other than your spouse or yourself) you will claim on your tax return. . . . D
E Enter “1” if you will use the filing status Head of Household (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . E
F Total number of allowances claimed. Add steps A through E. If you plan to itemize deductions on your 2021 Minnesota income tax return, you may also complete the itemized Deductions and Additional Income Worksheet.
Complete Section 2 if you claim to be exempt from Minnesota income tax withholding (see Section 2 instructions for qualifications). If applicable, check one box below to indicate why you believe you are exempt:

Section 2 — Exemption From Minnesota Withholding
Type a question

A I meet the requirements and claim exempt from both federal and Minnesota income tax withholding.
B Even though I did not claim exempt from federal withholding, I claim exempt from Minnesota withholding, because:
- I had no Minnesota income tax liability last year
- I received a refund of all Minnesota income tax withheld
- I expect to have no Minnesota income tax liability this year
C All of these apply:
- My spouse is a military service member assigned to a military location in Minnesota
- My domicile (legal residence) is in another state
- I am in Minnesota solely to be with my spouse.
If, "I am in Minnesota solely to be with my spouse", what is your state of domicile?
D I am an American Indian that resides and works on a reservationE I am a member of the Minnesota National Guard or an active duty U.S. military member and claim exempt from Minnesota withholdingF I receive a military pension or other military retirement pay as calculated under U.S. Code, title 10, sections 1401 through 1414, 1447 through 1455, and 12733, and I claim exempt from Minnesota withholding on this retirement pay
Minnesota Allowances and Additional Withholding
1 Minnesota Allowances. Enter Step F from Section 1 above or Step 10 of the Itemized Deductions Worksheet . .
2 Additional Minnesota withholding you want deducted each pay period (see instructions) . . . . . . . . . . . . . . . . . . .
I certify that all information provided in Section 1 OR Section 2 is correct. I understand there is a $500 penalty for filing a false Form W-4MN.
Signature

Clear
Date

MonthDayYear
Date
Daytime Phone Number
Program Engagement ID
Should be Empty:

2023 W-4MN, Minnesota Employee Withholding Allowance/Exemption Certificate

Employees

Minnesota Allowances and Additional Withholding