Form MW4

Montana Employee's Withholding and Exemption Certificate

Who is your Employer?

Business Name Please

Employees first name and middle initial

Last name

Social Security Number

Physical address

City

State

ZIP Code

1. Federal Filing Status

Single or married filing seperately (if you have multiple jobs, complete the Multiple Jobs Worksheet)Married filing joint or qualifying surviving spouse (if you and your spouse have multiple jobs. see line 2)Head of HouseholdMarried Filing Jointly with Both Spouses Working (if you are married and you and your spouse are both working and earn similar wages, mark this box. If you and your spouse have multiple jobs, and your spouse earns significantly more or less than you, do not mark this box. Instead, mark box 1b, then complete the Multiple Jobs Worksheet on page 2 and enter the result on line 3.

3. Extra Withholding: Enter in any additional tax you want withheld from your wages each pay period.

4. Specified Withholding: Enter the amount you want to withhold from retirement distributions or unemployment compensation. If you expect to report large federal adjustments, federal itemized deductions, Montana subtractions, and/or Montana tax credits, you can direct your employer to withhold the amount you report on this line. (See instructions)

5. Are you exempt from Montana Withholding? (If Yes we will contact you directly for further questions).

Please complete this section only if any of the questions above apply to you and you are specifically instructed to do so. If none of the previous questions apply, you may skip the following section and proceed directly to the signature and date fields at the bottom.

If you are required to complete Page 2, you will need access to the tables referenced in the instructions below. Be sure to review them carefully before proceeding.You can view the tables here.

#1: Two jobs If you have two jobs or you are married filing jointly and you and your spouse each have one job find the amount from the appropriate table on page 5 or 6 Using the Higher Paying Job row and the Lower Paying Job column find the value at the intersection of the two household salaries and enter that value here.

#2: Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.

#2a: Find the amount from the appropriate table on page 5 or 6 using the annual wages from the highest paying job in the Higher Paying Job row and the annual wages for your next highest paying job in the Lower Paying Job column Find the value at the intersection of the two household salaries and enter that value here.

2b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the Higher Paying Job row and use the annual wages for your third job in the Lower Paying Job column to find the amount from the appropriate table on page 5 or 6 and enter this amount on line 2b.

2c Add lines 2a and 2b

3 Enter the number of pay periods per year for the highest paying job. For example if that job pays weekly enter 52 If it pays every other week enter 26 If it pays monthly enter 12.

4 Divide the annual amount on line 1 or line 2c by the amount of pay periods on line 3 Enter this amount here and on Form MW4 line 3 of the Form MW4 for the highest paying job along with any other additional amount you want withheld.

Signature

Date

Page 2: Multiple Jobs Worksheet