Section 2 - Federal Withholding Form W-4
Section 1 - Employee Information
e federal worksheet is available online at http://www.irs.gov/pub/irs-pdf/fw4.pdf
RG
Agency Number
Payroll System (check one)
Name of Employing Agency
Social Security Number
Home Address (number and street or rural route)
Employee Name
Address Continued (apartment number, if any)
5
Total number of allowances you are claiming (from page 1 or page 2 of the federal worksheet)
6 Additional amount, if any, you want withheld from each paycheck .....................................................................................
7
I claim exemption from withholding for 2012, and I certify that I meet both of the following conditions for exemption.
If you meet both conditions, write “Exempt” here.........................................................................
7
3 Single Married Married, but withhold at higher Single Rate
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
5
6
e Maryland worksheet is available online at http://forms.marylandtaxes.com/current_forms/MW507.pdf
Pennsylvania (indicate township/borough under Address Continued in section 1 above.) Virginia
AND
income tax withheld. (is includes seasonal and student employees whose annual income will be below the
a. Last year I did not owe any Maryland income tax and had a right to a full refund of all income tax withheld.
b. is year I do not expect to owe any Maryland income tax and expect to have the right to a full refund of all
minimum ling requirement).
If both
FOR MA
AND S
TE G
RNM
T
MP
S ONLY
2007
Form W-4
Department of the Treasury
Internal Revenue Service
Form MW 507
Comptroller of Maryland
Please complete form in black ink. Whether you are entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
Section 3 - Maryland Withholding Form MW 507
Section 4 - Employee Signature
Date_________________________
Under penalties of perjury, I declare that I have examined this certicate and to the best of my knowledge and belief, it is true, correct, and complete. I
further certify that I am entitled to the number of withholding allowances claimed on line 1 above, or if claiming exemption from withholding, that I am
entitled to claim the exempt status on line 3, 4 or 5, whichever applies.
Employee’s signature
(Form is not valid
unless you sign it.) __________________________________________________________________
Important: e information you supply must be complete. is form will replace in total any certicate you previously submit
ted.
Web Site - http://compnet.comp.state.md.us/cpb
$
2. Additional withholding per pay period under agreement with employer 2. _________________________________
1.
Total number of exemptions you are claiming from Maryland worksheet 1. _________________________________
3.
I claim exemption from withholding because I do not expect to owe Maryland tax. See instructions below and check boxes that apply.
a and b
apply, enter year applicable _______ (year eective) Enter “EXEMPT” here 3._________________________________
4.
I claim exemption from withholding because I am domiciled in one of the following states. Check state that applies.
I further certify that I do not maintain a place of abode in Maryland as described in the instructions on page 2 of the worksheet
Enter “EXEMPT” here 4. _________________________________
5.
I certify that I am a legal resident of the state of_______ and am not subject to Maryland withholding because I meet the requirements
set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act.
Enter “EXEMPT” here 5._________________________________
Employee Withholding Allowance Certicate
2012
Withhold at Single Rate Married (surviving spouse or unmarried Head of Household) Rate Married, but withhold at Single Rate
UMCT
Federal Employer identication number
52-6002033
(For State of Maryland - CPB use only)
Employer’s name and address (including zip code) (For employer use only)
Central Payroll Bureau
P.O. Box 2396
Annapolis, MD 21404
• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and
• is year I expect a refund of all federal income tax withheld because I expect to have no tax liability
City
State
Zip Code
County of Residence (required)
4 If your last name diers from that shown on your social security card,
check here. You must call 1-800-772-1213 for a replacement card.
