- Paper: Letter (8.5in x 11in)
- Copies to print: 2
- The employee must complete this form if they choose any of the following:
- They wish to claim a greater number of allowances for state than for federal purposes.
- They wish to claim fewer withholding allowances for state than for federal purposes.
- They request an additional dollar amount or a flat dollar amount of withholding.
- This form must be submitted for approval to:
Maine Revenue Services
PO Box 1060
Augusta ME 04332-1060
- Each certificate expires on December 31 of the year it was submitted or whenever the employee or payee no longer qualifies for the certificate, whichever is sooner.
- Once reviewed, two copies of the certificate will be mailed to the employee: one should be given to the employer and the other for the employee's records.
- To be used by employees who want to change their state allowances from their federal allowances.