Massachusetts Massachusetts Employee's Withholding Exemption Certificate

Massachusetts Employee's Withholding Exemption Certificate
M-4
MASSACHUSETTS EMPLOYEE’S WITHHOLDING EXEMPTION CERTIFICATE

Rev. 11/19
ID

Print full name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Print home address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Employee:

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AC

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AT E

PE TI T

O V I E TE M

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FORM
M-4

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Social Security no. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City. . . . . . . . . . . . . . . . . . . . . . . State. . . . . . . . . . . . . . . Zip . . . . . . . . . . . . . . . .
AM

SV

B

HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS

File this form with your employer. Otherwise, Massachusetts Income Taxes will be
withheld from your wages
without exemptions.

1. Your personal exemption. Write the figure “1.” If you are age 65 or over or will be before next year, write “2”. . . . . . .
be before next year and if otherwise qualified, write “5.” See Instruction C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

........

Employer:

3. Write the number of your qualified dependents. See Instruction D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

........

Keep this certificate with your
records. If the employee is
believed to have claimed
excessive exemptions, the
Massachusetts Department
of Revenue should be so
advised.

4. Add the number of exemptions which you have claimed above and write the total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

........

2. If married and if exemption for spouse is allowed, write the figure “4.” If your spouse is age 65 or over or will

5. Additional withholding per pay period under agreement with employer $_____________________
A.

Check if you will file as head of household on your tax return.

B.

Check if you are blind.

D.

Check if you are a full-time student engaged in seasonal, part-time or temporary employment whose estimated annual income
will not exceed $8,000.

C.

Check if spouse is blind and not subject to withholding.

EMPLOYER: DO NOT withhold if Box D is checked.
I certify that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled.
Date. . . . . . . . . . . . . . . . . . . . . . . . . . . Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

THIS FORM MAY BE REPRODUCED

THE COMMONWEALTH OF MASSACHUSETTS, DEPARTMENT OF REVENUE
A. Number. The more exemptions you claim on this certificate, the less tax
withheld from your employer. If you claim more exemptions than you are
entitled to, civil and criminal penalties may be imposed. However, you may
claim a smaller number of exemptions without penalty. If you do not file a
certificate, your employer must withhold on the basis of no exemptions.
If you expect to owe more income tax than will be withheld, you may either
claim a smaller number of exemptions or enter into an agreement with your
employer to have additional amounts withheld.
You should claim the total number of exemptions to which you are entitled to
prevent excessive overwithholding, unless you have a significant amount of
other income. Underwithholding may result in owing additional taxes to the
Commonwealth at the end of the year.
If you work for more than one employer at the same time, you must not claim
any exemptions with employers other than your principal employer.
If you are married and if your spouse is subject to withholding, each may
claim a personal exemption.
B. Changes. You may file a new certificate at any time if the number of
exemptions increases. You must file a new certificate within 10 days if the
number of exemptions previously claimed by you decreases. For example,
if during the year your dependent son’s income indicates that you will not

provide over half of his support for the year, you must file a new certificate.
C. Spouse. If your spouse is not working or if she or he is working but not
claiming the personal exemption or the age 65 or over exemption, generally you may claim those exemptions in line 2. However, if you are planning to
file separate annual tax returns, you should not claim withholdingg exemptions for your spouse or for any dependents that will not be claimed on your
annual tax return.
If claiming a spouse, write “4” in line 2. Entering “4” makes a withholding system adjustment for the $4,400 exemption for a spouse.
D. Dependent(s). You may claim an exemption in line 3 for each individual
who qualifies as a dependent under the Federal Income Tax Law. In addition,
if one or more of your dependents will be under age 12 at year end, add “1”
to your dependents total for line 3.
You are not allowed to claim “federal withholding deductions and adjustments” under the Massachusetts withholding system.
If you have income not subject to withholding, you are urged to have additional amounts withheld to cover your tax liability on such income. See line
5.