Submission #

• Paper: Letter (8.5in x 11in)

• Copies: 2

• This certificate much be filed each year to continue exemption.
• This certificate must be kept with the employer's records.
• The employer must be notified within 10 days of any change making the employee no longer eligible for the exemption.
• Employers may use this form to report a newly hired or rehired employee. Mail completed form, within 20 days of hiring to:

Notes#

• The following conditions must apply to qualify for exemption:
  • the employee must be under age 18, or over age 65, or a full-time student under age 25,
  • the employee did not have income tax liability for the previous year,
  • the employee does not expect to have income tax liability for 2017.
• The employee may also claim exemption if they meet the conditions set forth under the Servicemembers Civil Relief Act.

Purpose#

To be used by residents to file exemption from state withholding tax.

Learn more#

Employer's Guide to Withholding Tax

Download#

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