Form MO W-4: Missouri Employee's Withholding Certificate

Enter your Full Name and Social Security Number.

Enter your Home Address (Number and Street or Rural Route), City or Town, State and ZIP Code.

Check the appropriate filing status: Single or Married Spouse Works or Married Filing Separate, Married (Spouse does not work), or Head of Household.

If you expect to have a balance due (as a result of interest income, dividends, income from a part-time job, etc.) on your tax return, you may request your employer to withhold an additional amount of tax from each pay period. To calculate the amount needed, divide the amount of the expected tax by the number of pay periods in a year. Enter the additional amount to be withheld each pay period on line 2.

If you expect to receive a refund (as a result of itemized deductions, modifications or tax credits) on your tax return, you may direct your employer to only withhold the amount indicated on line 3. Your employer will not use the standard calculations for withholding. To calculate the amount needed, divide the amount of your expected tax by the number of pay periods in a year. Enter the amount to be withheld instead of the standard calculation. If you designate an amount that is too low, it could result in you being under withheld. If no amount is indicated on line 3, the standard calculations will be used.

Select the appropriate reason you are claiming an exemption from withholding and indicate EXEMPT on line 4. One reason: you had a right to a refund of all Missouri income tax withheld last year and expect to have no tax liability this year. A new MO W-4 must be completed annually if you wish to continue the exemption.

Or: I am exempt because I meet the conditions set forth under the Servicemember Civil Relief Act, as amended by the Military Spouses Residency Relief Act and have no Missouri tax liability.

Or: I am exempt because my income is earned as a member of any active duty component of the Armed Forces of the United States and I am eligible for the military income deduction.

Under penalties of perjury, you certify that the information provided on this form is true and accurate.

Sign on Employee's Signature (the form is not valid unless you sign it) and enter the Date (MM/DD/YYYY).

Enter the Employer's Name, Employer's Address, City, State and ZIP Code.

Enter the Date Services for Pay First Performed by Employee (MM/DD/YYYY), the Federal Employer I.D. Number and the Missouri Tax Identification Number.

Notice to Employer: Within 20 days of hiring a new employee, a copy of the Employee's Withholding Certificate (Form MO W-4) must be submitted by one of the following methods: Email: withholding@dor.mo.gov; Fax: 877-573-6172; Mail to: Missouri Department of Revenue P.O. BOX 3340 Jefferson City, MO 65105-3340. Please visit dss.mo.gov/child-support/employers/new-hire-reporting.htm for additional information regarding new hire reporting.

Mail to: Taxation Division P.O. Box 3340 Jefferson City, MO 65105-3340 Phone: (573) 522-0967 Fax: 877-573-6172

The MO W-4 Employee's Withholding Certificate is for income tax withholding and child support enforcement purposes only. Type or print. Items to Remember: Employees must complete a new form if their filing status changes or to adjust the amount of withholding. If you are claiming an "Exempt" status due to the Military Spouses Residency Relief Act you must provide to your employer one of the following: Leave and Earnings Statement of the non-resident military servicemember; Form W-2 issued to the nonresident military servicemember; a military identification card; or specific military orders received by the servicemember. You must also provide verification of residency such as a copy of your state income tax return filed in your state of residence, a property tax receipt from the state of residence, a current drivers license, vehicle registration or voter ID card. For additional assistance in regard to Military, visit the department's website dor.mo.gov/military/. Additional information can be found at mo.gov/business/withhold/.