W4 MN STATE

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 year and when your personal or financial situation changes.

Name*

First Name and InitialLast Name

Social Security Number*

Marital Status (Check one)

Single; Married, but legally separated; or Spouse is a nonresident alien

Marital Status (Check one)

Married

Marital Status (Check one)

Married, but withhold at higher Single rate

Permanent Address*

Street Address

City*

State*

2 letter state abbreviation (MN)

ZIP Code*

Complete Section 1 OR Section 2, then sign the bottom and give the completed form to your employer.

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: 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. Or 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.

E. Enter "1" if you will use the filing status Head of Household (see instructions)

F. Add steps A through E. If you plan to itemize deductions on your 2022 Minnesota income tax return, you may also complete the Itemized Deductions and Additional Income Worksheet.

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 for each pay period (see instructions)

Section 2 - Exemption From Minnesota Withholding

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

I expect to have no Minnesota income tax liability this year

A I meet the requirements and claim exempt from both federal and Minnesota income tax withholdingB 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

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. My state of domicile is:blanks

D. I am an American Indian that resides and works on a reservation. Enter the reservation name: blanks field. Enter your Certificate of Degree of Indian Blood (CDIB)/Enrollment numberblank

Military

E. I am a member of the Minnesota National Guard or an active duty U.S. military member and claim exempt from Minnesota withholding on my military payF. 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

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.

Employee's Signature*

Date*

Date

Daytime Phone Number*

Email*

example@example.com

MN DEPARTMENT

2022 W-4MN, Minnesota Withholding Allowance/Exemption Certificate