M4 Form

FORM M-4
MASSACHUSETTS EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE
Print full name
Address

Print home address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security no.
State
Employee: File this form with your em- ployer. Otherwise, Massachu- setts Income Taxes will be withheld from your wages without exemptions.

HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS
1. Your personal exemption. Write the figure "1." If you are age 65 or over or will be before next year, write "2"
2. If married and if exemption for spouse is allowed, write the figure "4." If your spouse is age 65 or over or will be before next year and if otherwise qualified, write "5." See Instruction C.
3. Write the number of your qualified dependents. See Instruction D.
4 Write the number of your qualified dependents. See Instruction D.
5. Additional withholding per pay period under agreement with employer $
.

Check if you will file as head of household on your tax return.Check if you are blind.Check if spouse is blind and not subject to withholding.Check if you are a full-time student engaged in seasonal, part-time or temporary employment whose estimated annual income will not exceed $8,000.
EMPLOYER: DO NOT withhold if Box D is checked.
I certify that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled.
Date.

MonthDayYear
Date
Signed

Clear
THE COMMONWEALTH OF MASSACHUSETTS, DEPARTMENT OF REVENUE
A. Number. The more exemptions you claim on this certificate, the less tax withheld from your employer. If you claim more exemptions than you are entitled to, civil and criminal penalties may be imposed. However, you may claim a smaller number of exemptions without penalty. If you do not file a certificate, your employer must withhold on the basis of no exemptions. If you expect to owe more income tax than will be withheld, you may either claim a smaller number of exemptions or enter into an agreement with your employer to have additional amounts withheld. You should claim the total number of exemptions to which you are entitled to prevent excessive overwithholding, unless you have a significant amount of other income. Underwithholding may result in owing additional taxes to the Commonwealth at the end of the year. If you work for more than one employer at the same time, you must not claim any exemptions with employers other than your principal employer. If you are married and if your spouse is subject to withholding, each may claim a personal exemption. B. Changes. You may file a new certificate at any time if the number of exemptions increases. You must file a new certificate within 10 days if the5. number of exemptions previously claimed by you decreases. For example, if during the year your dependent son's income indicates that you will not

provide over half of his support for the year, you must file a new certificate. C. Spouse. If your spouse is not working or if she or he is working but not claiming the personal exemption or the age 65 or over exemption, general- ly you may claim those exemptions in line 2. However, if you are planning to file separate annual tax returns, you should not claim withholdingg exemp- tions for your spouse or for any dependents that will not be claimed on your annual tax return. If claiming a spouse, write "4" in line 2. Entering "4" makes a withholding sys- tem adjustment for the $4,400 exemption for a spouse. D. Dependent(s You may claim an exemption in line 3 for each individual who qualifies as a dependent under the Federal Income Tax Law. In addition, if one or more of your dependents will be under age 12 at year end, add "1" to your dependents total for line 3. You are not allowed to claim "federal withholding deductions and adjust- ments" under the Massachusetts withholding system. If you have income not subject to withholding, you are urged to have addi- tional amounts withheld to cover your tax liability on such income. See line
Should be Empty:

FORM M-4

MASSACHUSETTS EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE

I certify that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled.

THE COMMONWEALTH OF MASSACHUSETTS, DEPARTMENT OF REVENUE