Form
Department of the Treasury
Internal Revenue Service
Employee’s Withholding Certificate
FOR MARYLAND STATE GOVERNMENT EMPLOYEES ONLY
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Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
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Give Form W-4 to your employer.
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Your withholding is subject to review by the IRS.
2021
Step 1 – Personal Information (Please complete form in black ink.)
Payroll System (check one)
RG CT UM
(b) Social Security Number
Home Address (number and street or rural route) (apartment number, if any)
Does the name match the name on your Social
Security card? If not, to ensure you get credit for
your earnings, contact SSA at 800-772-1213 or go
County of Residence (required)
(c) Single or Married filing separately
Married filing jointly (or Qualifying widow(er))
(Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who
can claim exemption from withholding, when to use the online estimator, and privacy.
Step 2:
Multiple Jobs
or Spouse Works
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of
withholding depends on income earned from all of these jobs.
Do only one of the following.
(a)
Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or
(b)
Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or
(c)
If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option
is accurate for jobs with
similar pay; otherwise, more tax than necessary may be withheld .................................................................................. ……………………….
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TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent
contractor, use the estimator.
Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most
accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3: If your income will be $200,000 or less ($400,000 or less if married filing jointly):
Claim Multiply the number of qualifying children under age 17 by $2,000 ……...
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$
Dependents
Multiply the number of other dependents by $500………………………….
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$______________
Add the amounts above and enter the total here . . . . . . . . . . . . .
$
Step 4
(a) Other income (not from jobs). If you want tax withheld for other income you expect
(optional):
this year that won’t have withholding, enter the amount of other income here. This may include
Other
interest, dividends, and retirement income . . . . . . . . . . . .
(b)
Deductions. If you expect to claim deductions other than the standard deduction and
want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result
here. . . . . . . . . . . . . . . . . . . . .
(c)
Extra withholding. Enter any additional tax you want withheld each pay period.
4(c)
$
Important: The information you supply must be complete. This form will replace in total any certificate you previously
submitted.
Web Site - https://www.marylandtaxes.gov/statepayroll/payroll-forms.php
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee’s signature (This form is not valid unless you sign it.) Date
Employer identification
number (EIN)
First date of
employment
Employer’s name and address
Central Payroll Bureau
P.O. Box 2396
Annapolis, MD 21404
