Employee Withholding Allowance Certificate

FOR MARYLAND
MA
AND S
STATE
TE GOVERNM
G
RNMENT
T EMP
MPLOYEES
S ONLY

2015
2007

Form W-4
-4
Department
Depa
tment of the Treasu
easury
Internal Revenue
R venue Service
vice

Form
orm MW 507
Comptroller
Compt
oller of Maryland
Ma land

Please
lease complete
c mplete form in black
bla k ink.
ink Whether
hether you
ou are
a e entitled to claim
laim a ce
certain
tain number of all
allowances
wances or exemption
exempti n ffrom
om withholding is
subject to revi
view
w by the IRS.
I
Your
our employer
empl er may be requi
equired
ed to send a copy of this form to the IRS.
I

Section 1 - Employee
Empl yee Information
Info mation
Payroll
oll System
stem (check one)

RG

CT

Name
ame of Empl
Employing
ing Agen
Agency

UM
ocial Secu
ecurityy Number
umber
Social

Agencyy Number
Agen
umber

Add
ddress
ess Continued (apartment
(apa tment numbe
number, if any)

Home Add
ddress
ess (number and street
st eet or rural
ural route)
oute)
City

State

Employee
Empl
yee Name
ame

Zip Code

(Nonresidents enter Maryland County or

Baltimore City where you are employed)

County of Residence (required)

Section 2 - Federal
ederal Withholding
ithholding Form W-4
-4

The federal wo
worksheet
ksheet is available online at http://ww
http://www.irs.g
.irs.gov/pub/irs-pdf/fw4.pdf
v/pub/irs-pdf/fw4.pdf
4
If
your
our
last
name
differs
from
f
om
that
shown
on
your
our
social
security
secu y card
ard,
ingle
Mar
Married
ied
Married
Mar ied, but withhold at higher Single
ingle Rate
3 Single
checkk here.
che
here You
ou must
ust call
all 1-800-772-1213 for a replacement card.
ard.
Note
ote. If married
mar ied, but legally
legal y separated,
separated or spouse is a nonresident
non esident alien
alien, che
checkk the Singl
ingle b
box.

5 Total
otal number of all
allowances
wances you
ou aaree claiming
laiming (f
(from
om page 1 or page 2 of the federal wo
worksheet)
ksheet)
6 Additional
dditional amount,
amount if any,
an you
ou want withheld ffrom
om each payche
pa heckk .....................................................................................

5
6 $

7 I claim
laim exemption ffrom
om withholding for 2015,
2015 and I ce
certify
tify that I meet both of the following
foll wing conditions for exemption.
Last year I had a right to a refund of all federal income tax withheld because I had no tax liability and
This year I expect a refund of all federal income tax withheld because I expect to have no tax liability
If you
ou meet both conditions
conditi ns, write
ite Exemp
Exempt he
here.........................................................................
e.........................................................................

Section
ection 3 - Maryland
Ma land Withholding
ithholding Form
m MW 507
The Maryland
Ma land worksheet
wo ksheet is available online at http://forms.ma
http://forms.marylandtaxes.com/cur
landtaxes.com/current_forms/MW507.pdf
ent_forms/MW507.pdf

Withhold at Single Rate

Married (surviving spouse or unmarried Head of Household) Rate

Married, but withhold at Single Rate

1. Total
otal number of exemptions you
ou are
a e claiming
laiming not to exceed line f in Personal Exemption Worksheet on page 2. . .

1.________________

2. Additional
dditional withholding per pay pe
period
iod under agreement
ag eement with employer.
empl yer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.________________
3. I claim
laim exemption fro
from
m withholding be
because
ause I do not expect to owe
we Maryland
Ma land tax.
tax See instructions and check boxes that apply.
a. Last
ast year I did not owe
we any Maryland
Ma land income tax and had a right
ight to a full refund
efund of all income tax withheld and
b
b. This year I do not expect to owe
we any Maryland
Ma land income tax and expect to have the right
ight to a full refund
efund of all income tax withheld.
withheld
(This
(This in
includes
ludes seasonal and student empl
employees
ees whose annual income will
wi l be below
bel w the minimum
mini um filing requi
equirements)
ements).
If both a and b apply,
app enter year applicable
appli able _______ (year effective) Enter EXEMPT
PT he
here.
e. . . . . . . . . . . . . .
3.________________
4. I claim
laim exemption fro
from
m withholding be
because
ause I am domiciled in the foll
following
wing state.
state
Virginia
irginia
I further
fu ther certify
ce tify that I do not maintain a place of abode in Ma
Maryland
land as described
desc ibed in the instructi
inst uctions.
ns.
Enter EXEMPT he
heree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.________________
5. I claim exemption from Maryland state withholding because I am domiciled in the Commonwealth of Pennsylvania
and I do not maintain a place of abode in Maryland as described in the instructions on Form MW507.
Enter EXEMPT here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. I claim exemption from Maryland local tax because I live in a local Pennysylvania jurisdiction within York or
Adams counties. Enter EXEMPT here and on line 4 of Form MW507. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. I claim exemption from Maryland local tax because I live in a local Pennsylvania jurisdiction that does not impose
an earnings or income tax on Maryland residents. Enter EXEMPT here and on line 4 of Form MW507. . . . . .
8. I certify that I am a legal resident of the state of ____________ and am not subject to Maryland withholding because
l meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses
Residency Relief Act. Enter EXEMPT here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.________________
6.________________
7.________________

8.________________

Section
ection 4 - Employee Signature
nature

Under penalties of perjury,

perju I decla
de laree that I have examined this certifi
ce tificate
ate and to the best of my knowledge
kn wledge and belie
belief, it is true,
t
correct
cor
ect, and complete
complete. I
further
fu
ther ce
certify
tify that I am entitled to the number of withholding all
allowances
wances claimed
laimed on line 1 ab
above, or if claiming
laiming exemption from
fr om withholdin
withholding, that I am
entitled to claim
laim the exempt status on which ever
ver line(s) I completed.

Employe
Empl
yeess signature
si nature
(Form
orm is not valid unless you
ou sign it.) __________________________________________________________________

Employers name and address (including zip code) (For employer use only)
Central Payroll Bureau
P.O. Box 2396
Annapolis, MD 21404

Date_________________________

Federal Employer identification number

52-6002033
(For State of Maryland - CPB use only)

Impo tant: The informa

Important
info mation
ion you
ou supply
supp y must
ust be complete.
complete This form
fo m will
wi l replace in total any
a y ce
certifi
ificate
ate you
ou pr
previous
viouslyy submitted.
submit ted.
Web
eb Site
ite - http://compnet.comp.state.md.us/cpb
http://compnet.c
.state.md.us/cpb