MAINE Form W-4ME
Employee's Withholding Allowance Certificate
1. Type or print your first name
First Name
Middle Initial
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2. Your social security number
3.
Single or Head of Household
Married
Married, but withholding at higher single rate Note: If married but legally separated, or spouse is a nonresident alien, check the single box.
4. Total number of allowances you are claiming on the Personal Allowances Worksheet.
5. Additional amount, if any, you want withheld from your paycheck.
a. You wrote "Exempt" on your federal Form W-4.
b. You wrote "No Withholding" on your federal Form W-4P.
c. You are a resident employee with no Maine tax liability in prior and current years.
d. You are a recipient of periodic retirement payments with no tax liability in prior and current years.
e. 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.
7. Check this box if you are an enrolled tribal member residing on tribal land in Maine and you are claiming an exemption from Maine withholding on the wages, salaries, or other compensation derived from or connected with sources on tribal land in Maine (that is, wages, salaries, or other compensation for work performed in Maine on tribal land). See instructions for additional information.
EMPLOYEE'S/PAYEE'S SIGNATURE
(Form is not valid unless you sign it.)
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
8. Employer/Payer Name
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