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1 Minnesota wages and Minnesota tax withheld on Forms W-2, other than from Forms W-2G. If you have more than ve Forms W-2,
complete line 5 on the back.
A B—Box 13 C—Box 15 D—Box 16 E—Box 17
If the Form W-2 is for: If Rerement Plan Employer’s seven-digit Minnesota State wages, ps, etc. Minnesota tax withheld
• you, enter 1 box is checked, Tax ID Number (round to nearest whole dollar) (round to nearest whole dollar)
• spouse, enter 2 mark an X below.
Subtotal for addional Forms W-2 (from line 5 on page 2) ............................................
Total Minnesota tax withheld on all Forms W-2 (add amounts in line 1, column E)
.................... 1
2 Minnesota tax withheld on Forms 1099, W-2G, and 1042-S. If you have more than four forms, complete line 6 on the back.
A B C D
If the Form 1099, W-2G, or 1042-S is for: Payer’s seven-digit Minnesota Tax ID Income amount (see the table on Minnesota tax withheld
• you, enter 1 Number (if unknown, contact the payer) the back for amounts to include) (round to nearest whole dollar)
• spouse, enter 2
Subtotal for addional 1099, W-2G, and 1042-S (from line 6 on page 2) ...............................
Total Minnesota tax withheld on all 1099, W-2G, and 1042-S (add amounts in line 2, column D) ......... 2
3 TotalMinnesotataxwithheldbypartnerships,Scorporaons,andduciaries
(from line 7 on page 2) ....................................................................... 3
4 Total. Add the Minnesota tax withheld on lines 1, 2, and 3.
Enter the total here and on line 24 of Form M1 .................................................. 4
IncludethisschedulewithyourFormM1.
Ifrequired,includeSchedulesKPI,KS,andKF.
2019ScheduleM1W,MinnesotaIncomeTaxWithheld
Complete this schedule to report Minnesota income tax withheld. Include this schedule when you le your return.
If you received a federal Form W-2, 1099, W-2G, 1042-S, or Minnesota Schedule KPI, KS, or KF that shows Minnesota income tax withheld,
complete this schedule to determine line 24 of Form M1. List only the forms that report Minnesota income tax withheld. Round dollar
amounts to the nearest whole dollar. You must include this schedule when you le your return. DO NOT send in your Forms W-2, 1099, or
W-2G; keep them with your tax records. All instrucons are included on this schedule.
9995
YourFirstNameandInial LastName YourSocialSecurityNumber
IfaJointReturn,Spouse’sFirstNameandInial Spouse’s
LastName
Spouse’sSocialSecurityNumber
*191311*