(Rev. 12-20)
This certicate is for Michigan income tax withholding purposes only. Read instructions on page 2 before completing this form.
Issued under P.A. 281 of 1967.
41. Full Social Security Number 42. Date of Birth
43. Name (First, Middle Initial, Last)
4. Driver’s License Number or State ID
Home Address (No., Street, P.O. Box or Rural Route)
45. Are you a new employee?
Yes If Yes, enter date of hire........
City or Town State ZIP Code
6. Enter the number of personal and dependent exemptions (see instructions) ........................................................... 46.
$ .00
7. Additional amount you want deducted from each pay (if employer agrees) ...................................................................7.
8. I claim exemption from withholding because (see instructions):
a. A Michigan income tax liability is not expected this year.
b. Wages are exempt from withholding. Explain: ___________________________________________________________________________________________________
c. Permanent home (domicile) is located in the following Renaissance Zone: _____________________________________________________________________
EMPLOYEE: If you fail or refuse to le this form, your employer must withhold Michigan income tax from your wages without allowance for any
exemptions. Keep a copy of this form for your records. See additional instructions on page 2.
Under penalty of perjury, I certify that the number of withholding exemptions claimed on this certicate does not exceed the number I am allowed to
claim. If claiming exemption from withholding, I certify that I do not anticipate a Michigan income tax liability this year.
9. Employee’s Signature
EMPLOYER: Complete the below section.
10. Employer’s Name
411. Federal Employer Identication Number
Address (No., Street, P.O. Box or Rural Route) City or Town State ZIP Code
Name of Contact Person Contact Phone Number
INSTRUCTIONS TO EMPLOYER: Keep a copy of this certicate with your records. All new hires must be reported to the State of Michigan. See
www.mi-newhire.com for information.
In addition, a copy of this form must be sent to the Michigan Department of Treasury if the employee claims 10 or more exemptions or claims they are
exempt from withholding. Send a copy to:
Michigan Department of Treasury
Tax Technical Section
P.O. Box 30477
Lansing, MI 48909
Reset Form
You must submit a Michigan withholding exemption
certificate (form MI-W4) to your employer on or before
the date that employment begins. If you fail or refuse
to submit this certificate, your employer must withhold
tax from your compensation without allowance for any
exemptions. Your employer is required to notify the
Michigan Department of Treasury if you have claimed 10
or more personal or dependency exemptions or claimed
that you are exempt from withholding.
You MUST provide a new MI-W4 to your employer
within 10 days if your residency status changes or if
your exemptions decrease because: a) your spouse, for
whom you have been claiming an exemption, is divorced
or legally separated from you or claims his/her own
exemption(s) on a separate certificate, or b) a dependent
no longer qualifies under the Internal Revenue Code.
Line 5: If you check “Yes,” enter your date of hire.
Line 6: Personal and dependency exemptions. The
number of exemptions claimed here may not exceed
the number of exemptions you are entitled to claim on a
Michigan Individual Income Tax Return (Form MI-1040).
Dependents include qualifying children and qualifying
relatives under the Internal Revenue Code, even if your
AGI exceeds the limits to claim federal tax credits for
Do not claim the same exemptions more than once or tax
will be under-withheld. Specifically, do not claim:
Your personal exemption if someone else will claim
you as their dependent.
Your personal exemption with more than one
employer at a time.
Your spouse’s personal exemption if they claim it
with their employer.
Your dependency exemptions if someone else (for
example, your spouse) is claiming them with their
Line 7: You may designate additional withholding if you
expect to owe more than the amount withheld.
Line 8a: You may claim exemption from Michigan income
tax withholding if all of the following conditions are met:
i) Your employment is intermittent, temporary, or less
than full time;
ii) Your personal and dependency exemptions exceed
your annual taxable compensation;
iii) You claimed exemption from federal withholding;
iv) You did not incur a Michigan income tax liability for
the previous year.
Line 8b: Reasons wages might be exempt from
withholding include:
You are a nonresident spouse of military personnel
stationed in Michigan.
You are a resident of one of the following reciprocal
states while working in Michigan: Illinois, Indiana,
Kentucky, Minnesota, Ohio, or Wisconsin.
You are an enrolled member of a federally-
recognized tribe that does not have a tax
agreement with the state of Michigan, you reside
within that tribe’s Indian Country (as defined in 18
USC 1151), and compensation from this job will be
earned within that Indian Country.
Line 8c: For questions about Renaissance Zones,
contact your local assessors office.