W-4 ME

MAINE
W-4ME
Type or print your first name
M.I.
Last name
2. Your social security number
Home address (number and street or rural route)
City or Town
State
ZIP code
4. Total number of allowances you are claiming from line E of the personal allowances worksheet below.
5. Additional amount, if any, you want withheld from your paycheck
6. If you do not want any state income tax withheld, check the appropriate box that applies to you (you must qualify - see instructions below By signing below, you certify that you qualify for the exemption that you select:
Under penalties of perjury, I certify that I am entitled to the number of withholding allowances or the exemption claimed on this certificate.
EMPLOYEE'S/PAYEE'S SIGNATURE
(Form is not valid unless you sign it.)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

MAINE