Form 89-350-98-1 Rev.4/99
State Tax Commission
P.O. Box 960
Jackson Mississippi 39205
IMPORTANT: THIS CERTIFICATE MAY BE USED FOR PAY PERIODS IN CALENDAR YEAR 2000 and after
Employee's Name Social Security Number
Employee's Residence Address
Number and Street City or Town State Zip Code
EMPLOYEE:
File this form with
your employer.
Otherwise, he must
withhold Mississippi
income tax from the
full amount of your
wages.
EMPLOYER:
Keep this
certificate with
your records. If the
employee is believed
to have claimed
excess exemption,
the State Tax
Commission should be
advised.
CLAIM YOUR WITHHOLDING PERSONAL EXEMPTION
Marital Status
1.Single
2.Married
(Check
One)
Personal Exemption Allowed
( )Enter $6,000 as exemption................................
Amount Claimed
$
(a)
(b)
( )Spouse IS employed: Enter that part of $12,000 claimed by
you, in multiples of $500. See instructions 2(b)below.......
( )Spouse NOT employed:Enter$12,000.........................
Head of
Family
4. Dependents
Number Claimed
( )Enter $9,500 as exemption. To qualify as head of family,
you must be single and have a dependent living in the home
with you. See instructions 2(c) & (d)
below.......................................................
You may claim $1,500 for each dependent,* other than for
taxpayer and spouse, who receives chief support from you and
who qualifies as a dependent for Federal income tax purposes.
*A head of family may claim $1,500 for each dependent
excluding the one which qualifies you as head of family.
Multiply number of dependents claimed by you by $1,500. Enter
amount claimed..............................................
5. Age and
Blindness
Exemption
Age 65 or older ( )Husband ( )Wife ( ) Single
Blind ( )Husband ( )Wife ( ) Single
Multiply number of blocks checked by $1,500. Enter amount
claimed.....................................................
Note: No exemption allowed for age or blindness for
dependents.
Effective only for
pay periods in 2000
and after
6. TOTAL AMOUNT OF EXEMPTION CLAIMED - Lines 1 through 5....................
I declare under the penalties imposed for filing false reports that the amount of exemption claimed on this certificate does
not exceed the amount to which I am entitled.
Date: Employee's Signature:
$
7. Additional dollar amount withholding per pay period if agreed to by
your employer.........................................................
INSTRUCTIONS
$
1. THE PERSONAL EXEMPTIONS ALLOWED ARE:
(a) Single individuals - $6,000
(b) Married individuals (jointly) - $12,000
(c) Head of family - $9,500
(d) Dependents - $1,500
(e) Aged 65 and over - $1,500
(f) Blindness - $1,500
2. CLAIMING PERSONAL EXEMPTIONS:
(a) SINGLE INDIVIDUALS enter $6,000 on Line 1.
(b) MARRIED INDIVIDUALS are allowed a joint exemption of $12,000.
If the spouse is not employed, enter $12,000 on Line 2(a). If the spouse
is employed, the exemption of $12,000 may be divided between
taxpayer and spouse in any manner they choose - in multiples of $500. For
example - taxpayer may claim $6,500 and spouse claims $5,500; or
taxpayer may claim $8,000 andspouse claims $4,000. The total claimed
by taxpayer and spouse may not ex- ceed $12,000. Enter amount claimed
by you on Line 2(b).
(c) A HEAD OF FAMILY is a single individual who maintains a home which
is the principal place of abode for himself and at least one dependent.
Single individuals qualifying as a head of family enter $9,500 on Line
3. If the taxpayer has more than one dependent, additional exemptions
are applicable. See item (d).
(d) An additional exemption of $1,500 may generally be claimed for each
dependent of the taxpayer. A dependent is any relative who receives
chief support from the taxpayer and who qualifies as a dependent for
Federal income tax purposes. Head of family individuals may claim an
additional exemption for each dependent excluding the one which is
required for head of family status. For example, a head of family tax-
payer has 2 dependent children and his dependent mother living with
him. The taxpayer may claim 2 additional exemptions. Married or single
individuals may claim an additional exemption for each dependent, but
should not include themselves or their spouse. Married taxpayers may
divide the number of their dependents between them in any manner
they choose; for example, a married couple has 3 children who qualify
as dependents. The taxpayer may claim 2 dependents and the spouse 1;
or the taxpayer 3 and the spouse none. Enter the amount of dependent
exemption on line 4.
(e) An additional exemption of $1,500 may be claimed by either taxpayer
or spouse or both if either or both have reached the AGE of 65 before the
close of the taxable year. No additional exemption is authorized for
dependents by reason of age. Check applicable blocks on Line 5.
(f) An additional exemption of $1,500 may be claimed by either taxpayer
or spouse or both if either or both are BLIND. No additional exemption is
authorized for dependents by reason of blindness. Check applicable
blocks on Line 5. Multiply number of blocks checked on Line 5 by
$1,500 and enter amount of exemption claimed.
3. TOTAL EXEMPTION CLAIMED:
Add the amount of exemptions claimed in each category and enter the
total on Line 6. This amount will be used as a basis for withholding income
tax under the appropriate withholding tables.
4. A NEW EXEMPTION CERTIFICATE MUST BE FILED WITH YOUR
EMPLOYER WITHIN 30 DAYS AFTER ANY CHANGE IN YOUR
EXEMPTION STATUS.
5. PENALTIES ARE IMPOSED FOR WILLFULLY SUPPLYING FALSE
INFORMATION OR WILLFUL FAILURE TO SUPPLY INFORMATION
WHICH WOULD REDUCE THE WITHHOLDING EXEMPTION.
6. IF THE EMPLOYEE FAILS TO FILE AN EXEMPTION CERTIFICATE
WITH HIS EMPLOYER, INCOME TAX MUST BE WITHHELD BY THE
EMPLOYER ON TOTAL WAGES WITHOUT THE BENEFIT OF
EXEMPTION.
7. IMPORTANT: USE THIS FORM ONLY FOR PAY PERIODS IN 2000
AND AFTER.
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MISSISSIPPI EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE
3.
