2017

2007
Employee Withholding Allowance Certificate
Form W-4 -4 FOR MARYLAND
MA AND STATE
S TE GOVERNM
G RNMENT T EMP
MPLOYEES S ONLY Form
orm MW 507
Department
Depa tment of the Treasu
easury Comptroller
Compt oller of Maryland
Ma land
Internal Revenue
R venue Service
vice
Please
lease complete
c mplete form in black
bla k ink.
ink Whether
hether you
ou are
a e entitled to claim
laim a certain
ce tain number of allowances
all wances or exemption
exempti n from
f om withholding is
subject to revi
view
w by the IRS.
I Your
our employer
empl er may be requiequired
ed to send a copy of this form to the IRS.
I

Section 1 - Employee
Empl yee Information
Info mation
oll System
Payroll stem (check one) ame of Employing
Name Empl ing Agency
Agen
RG CT UM
Agencyy Number
Agen umber ocial Secu
Social ecurityy Number
umber Employee
Empl yee Name
ame

Home Add
ddress
ess (number and street
st eet or rural
ural route)
oute) Add
ddress
ess Continued (apartment
(apa tment number,
numbe if any)

State Zip Code County of Residence (required) (Nonresidents enter Maryland County or
City Baltimore City where you are employed)

Section 2 - Federal
ederal Withholding
ithholding Form W-4
-4 The federal worksheet
wo ksheet is available online at http://www.irs.g
http://ww .irs.gov/pub/irs-pdf/fw4.pdf
v/pub/irs-pdf/fw4.pdf
3 Single
ingle Mar ied
Married Mar ied, but withhold at higher Single
Married ingle Rate 4 If your
our last name differs f
from
om that shown on your
our social secu y card
security 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. checkk here.
che here Youou must
ust call
all 1-800-772-1213 for a replacement card.
ard.

5 Total
otal number of allowances
all wances you
ou are
a e claiming
laiming (from
(f om page 1 or page 2 of the federal worksheet)
wo ksheet) 5
6 Additional
dditional amount,
amount if any,
an youou want withheld from
f om each payche
pa heckk ..................................................................................... 6 $
7 I claim
laim exemption from
f om withholding for 2017,
2017 and I certify
ce 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......................................................................... 7

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.marylandtaxes.com/16_forms/MW507.pdf
http://forms.ma landtaxes.com/16_forms/MW507.pdf
Single 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 period pe iod under agreement
ag eement with employer. empl yer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.________________
3. I claim
laim exemption fro from
m withholding because be ause I do not expect to owe we Maryland
Ma land tax. tax See instructions and check boxes that apply.
a. Lastast year I did not owewe any Maryland
Ma land income tax and had a right ight to a full refund efund of all income tax withheld and
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 includes
in ludes seasonal and student employees empl 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 applicableappli able _______ (year effective) Enter EXEMPT PT he here.e. . . . . . . . . . . . . . 3.________________
4. I claim
laim exemption fro from
m withholding because be ause I am domiciled in the following foll wing state.state
Virginia
irginia
I further
fu ther certify
ce tify that I do not maintain a place of abode in Maryland Ma land as describeddesc ibed in the instructiinst 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.________________
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.________________
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. . . . . . 7.________________
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.________________

ection 4 - Employee Signature

Section 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 belief,
belie it is true,
t correct
cor ect, and complete.
complete I
further
fu ther certify
ce tify that I am entitled to the number of withholding allowances
all wances claimed
laimed on line 1 above,
ab or if claiming
laiming exemption from
fr om withholding,
withholdin 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.) __________________________________________________________________ Date_________________________
Daytime phone number (in case CPB needs to contact you regarding your W4)____________________________________
Employers name and address (Employer: Complete name, address & EIN only if sending to IRS) Federal Employer identification number (EIN)
Central Payroll Bureau
P.O. Box 2396
Annapolis, MD 21404
Important
Impo tant: The informa
info mation
ion you
ou supp
supplyy must
ust be complete.
complete This form
fo m will
wi l replace in total any
a y certifi
ce ificate
ate you
ou previous
pr viouslyy submitted.
submit ted.
Web
eb Site
ite - http://compnet.comp.state.md.us/cpb
http://compnet.c .state.md.us/cpb