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
Single or Head of HouseholdMarriedMarried, but withholding at higher single rate
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:

6a. You claimed "Exempt" on your federal Form W-46b. You completed federal Form W-4P and checked the box on line 16c. You are a resident employee with no Maine tax liability in prior and current years6d. You are a recipient of periodic retirement payments with no tax liability in prior and current years6e. Your spouse is a member of the military assigned to a location in Maine and you qualify for exemption under the Military Spouse's Residency Relief Act. You must attach supporting documents. See instructions6e.
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
Date
Should be Empty:

MAINE