North Dakota Withholding Reciprocity Exemption [MN, MT Residents]

Withholding Reciprocity Exemption [MN, MT Residents]
Form NDW-R - Reciprocity Exemption from Withholding for a Qualifying Minnesota and Montana Residents Working in ND (2023)
FORM NDW-R - RECIPROCITY EXEMPTION FROM
WITHHOLDING FOR QUALIFYING MINNESOTA
AND MONTANA RESIDENTS WORKING IN
NORTH DAKOTA

For Calendar Year

20___

OFFICE OF STATE TAX COMMISSIONER
SFN 28729 (12-2023)

Please type or print in black or blue ink. Fill in circles completely.
See instructions on back before completing.

Employee information
Employee Social Security Number

Employee Name (Last, First, MI)
Employee Permanent Street Address
City

State

Minnesota
Montana

ZIP Code

Employee residency information
I have lived at the above address since (month/day/year) ____________________________
Will you return to the above address at least once a month? . . . . . . . . . . . . . . . . . . . YES

NO

If you are a resident of Minnesota and answer "No" to this question, you do not qualify for this exemption.
Were you ever a resident of North Dakota in the past three years? . . . . . . . . . . . . . . . YES

NO

If yes, fill in the dates you were a North
____________________________ to ____________________________
Dakota resident (month/day/year)
Fill in the wages you earned in North Dakota during the previous calendar year ____________________________

Employer Information
Current Employer's Name

Employer's Federal ID Number

Employer's Mailing Address

Telephone Number

City

State

ZIP Code

Employee's Signature
I declare, under the penalties of North Dakota Century Code § 12.1-11-02, which provides for a Class A misdemeanor for making
a false statement in a governmental matter, that this form has been examined by me and to the best of my knowledge and belief
is true, correct, and complete.
Employee's signature

Date signed

Employee's Telephone Number

Employee - Make a copy for your records. Give this completed form to you employer.
Employer - Verify that the Employer's Federal ID is correct. Make a copy for your records.
Mail this form to: Office of State Tax Commissioner, 600 E. Boulevard Ave., Dept. 127, Bismarck ND 58505-0599

tax.nd.gov

Form NDW-R
SFN 28729 (12-2023)

Instructions for employee
North Dakota has income tax reciprocity
agreements with Minnesota and
Montana. If you are a resident of one of
these states, the agreements provide
that you do not have to pay North
Dakota income tax on wages you earn
for work in North Dakota. If you are
a resident of Minnesota, this applies
only if you return to your permanent
residence in Minnesota at least once a
month.

Fill out the form completely

Instructions for employer

Your employer will be able to provide
you with the correct federal ID number
if you do not have this information.

Employees who reside in Minnesota or
Montana who ask you not to withhold
North Dakota income tax from their
wages must complete this form and
give it to you by February 28 or within
30 days after they begin working
for you or change their residence.
Employees who live in other states,
including North Dakota, cannot use this
form.

If you do not fill in every item on this
form, your employer must withhold
North Dakota income tax from your
wages. Sign and date the form. Your
phone number is not required, but we
ask for it so we can contact you if we
have questions.

Note: The wages you earn for
work in North Dakota are subject
to income tax in your state of
residence.

Make a copy of this form for your
records and give the original to your
employer.

If you do not want North Dakota
income tax withheld from your
wages, you must complete this
form and give it to your employer by
February 28 of the calendar year for
which you want it to apply, or within
30 days after you begin working or
change your permanent residence. You
must complete a new form and give it
to your employer each year to continue
the exemption from withholding.

Use of information

If you do not complete this form and
give it to your employer as explained
above, your employer must withhold
North Dakota income tax from your
wages.

Your name, address and social security
number are required for identification.
Your address is also required to verify
your state of residence. Your employer’s
name, address, federal ID number
and telephone number are required in
case we have to contact your employer
regarding withholding income tax from
your wages. If you do not complete
any of this information, your employer
is required to withhold North Dakota
income tax from your wages.

If North Dakota income tax was
already withheld from your wages,
you must complete and file a North
Dakota income tax return at the end of
the year to obtain a refund.

All information on this form is
confidential by state law. It may only
be given to your state of residence, the
Internal Revenue Service, other states
that guarantee the same confidentiality,
and to other state agencies as provided
by law. The information may be
compared with other information you
furnished to the Office of State Tax
Commissioner.

For forms received by February 28, mail
the original on or before March 31 to:
Office of State Tax Commissioner
600 E. Boulevard Ave., Dept. 127
Bismarck, ND 58505-0599
For new employees or employees who
change their permanent home address,
mail the original to the above address
within 30 days of receipt.
Please verify your federal ID
number is correct. Make a copy of the
completed form for your records.
If an employee does not fill in every
item on this form and the employee
does not correct the omission, you must
withhold North Dakota income tax from
the employee’s wages.
An employee must complete this form
and give it to you each year to continue
the exemption from withholding.

Need forms or assistance?
Visit our website
	 You can download tax forms, ask us a question or send us a message via email, and find other useful information on our
website at: www.tax.nd.gov.
Call us
	 For additional NDW-R forms, call 701-328-1243.
	 For questions about this form or about income tax withholding, please call 701-328-1248.
Write to us
	 You may also write to the Office of State Tax Commissioner, 600 E. Boulevard Ave., Dept. 127, Bismarck, ND 58505-0599.