Mo W 4 Form – Fill Out and Use This PDF

Employee

Employer Signature

Full Name		Social Security Number
Home Address (Number and Street or Rural Route)	City or Town	State					ZIP Code

1. Filing Status: Check the appropriate filling status below.

r Single or Married Spouse Works or Married Filing Separate

r Married (Spouse does not work)

rHead of Household

2.Additional withholding: 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

2

3.Reduced withholding: 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. If you designate an amount that is too low, it could result in you being under withheld. 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 no amount is indicated on

line 3, the standard calculations will be used.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4.Exempt Status: Select the appropriate reason you are claiming an exemption from withholding below and indicate

EXEMPT on line 4

4

rI am exempt because I 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.

rI 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.

rI 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, I certify that the information provided on this form is true and accurate.

Employee’s Signature (Form is not valid unless you sign it)						Date (MM/DD/YYYY)
						__ __ / __ __ / __ __ __ __
Employer’s Name	Employer’s Address
City	State			ZIP Code
Date Services for Pay First Performed by Employee (MM/DD/YYYY)		Federal Employer I.D. Number			Missouri Tax Identification Number
__ __ / __ __ / __ __ __ __		| | | | | | |	|		| | | | | | |

Mail to: Taxation Division P.O. Box 3340

Jefferson City, MO 65105-3340 Phone: (573) 522-0967

Fax: (573) 526-8079

Form MO W-4 (Revised 08-2021)

Ever served on active duty in the United States Armed Forces?

If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible military individuals. A list of all state agency resources and benefits can be found at veteranbenefits.mo.gov/state-benefits/.