Submission 

• Paper: Letter (8.5in x 11in)
• Copies to print: 2

Employers must keep a copy for their records.

Notes

• If the employee is a resident of Illinois, Indiana, Kentucky, or Michigan, they may claim exemption from Wisconsin withholding tax.
• A nonresident employee qualifying for this exemption must complete and file this declaration with his or her employer as authorization for the employer to stop the withholding of Wisconsin income taxes.