- Employee's Withholding Exemption Certificate - Massachusetts
- Employee's Withholding Exemption Certificate - Virginia
- Income Certification - Texas
- Employee's Withholding Certificate - Connecticut
- Employee's Withholding Exemption Certificate - Arkansas
- Employee's Withholding Allowance Certificate - New Jersey
Fillable Printable Employee Withholding Allowance/Exemption Certificate - Minnesota
Fillable Printable Employee Withholding Allowance/Exemption Certificate - Minnesota
Employee Withholding Allowance/Exemption Certificate - Minnesota
Section 2 — Exemption from Minnesota withholding
Complete Section 2 if you claim to be exempt from Minnesota income tax withholding (see Section 2 instructions for qualifi ca-
tions). If applicable, check one box below to indicate the reason why you believe you are exempt:
I meet the requirements and claim exempt from both federal and Minnesota income tax withholding.
Even though I did not claim exempt from federal withholding, I claim exempt from Minnesota withholding because I had no
Minnesota income tax liability last year, I received a refund of all Minnesota income tax withheld, AND I expect to have no Min-
nesota income tax liability this year.
My spouse is a military service member assigned to a military location in Minnesota, my domicile (legal residence) is in another
state, AND I am in Minnesota solely to be with my spouse. My state of domicile is .
I am an American Indian living and working on a reservation.
I am a member of the Minnesota National Guard or an active duty U.S. military member and claim exempt from Minnesota
withholding on my military pay.
2015 Minnesota Employee Withholding Allowance/Exemption
Employees: Give the completed form to your employer.
If you are required to send a copy of this form to the Department of Revenue (see instructions), you must enter the employer information below
and mail this form to: Minnesota Revenue, Mail Station 6501, St. Paul, MN 55146-6501. (Incomplete forms are considered invalid.) A $50
penalty may be assessed for each required Form W-4MN not fi led with the department.
Keep a copy for your records.
Employee’s signature Date Daytime phone
I certify that all information provided in Section 1 OR Section 2 is correct. I understand there is a $500 penalty for fi ling a false with-
holding allowance/exemption certifi cate.
You must complete and provide your employer with Form W-4MN if you:
• claim fewer Minnesota withholding allowances than your federal allowances;
• claim more than 10 Minnesota withholding allowances;
• want additional Minnesota withholding deducted from your pay each pay period; or
• claim to be exempt from federal withholding or claim to be exempt from Minnesota withholding.
If you are claiming the same number of Minnesota allowances as federal and the number claimed is 10 or less, do not complete this form.
Employee’s fi rst name and initial Last name Employee’s Social Security number
Marital status (check one box)
City State ZIP code
Married, but withhold at higher Single rate
Single; Married, but legally separated; or
Spouse is a nonresident alien
Employees: Read instructions on back, complete Section 1 OR Section 2, sign and give the completed form to your employer.
(Do not complete both Section 1 and Section 2. Completing both sections will make the form invalid.)
Section 1 — Determining Minnesota allowances
Complete Section 1 if you claim fewer Minnesota allowances than your federal allowances, AND/OR if you want additional Min-
nesota withholding deducted each pay period.
1 Total number of federal allowances claimed on federal Form W-4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Total number of Minnesota allowances (line 2 cannot be more than line 1) . . . . . . . . . . . . . . . . . . . . . . . 2
3 Additional Minnesota withholding you want deducted each pay period . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 $
Name of employer Federal employer ID number (FEIN) Minnesota tax ID number
Address City State ZIP code
Form W-4MN Instructions
When to Complete
Aft er you determine the number of federal
withholding allowances to claim on federal
Form W-4, you must determine the number
of Minnesota withholding allowances to
If you claim the same number of Minne-
sota allowances as federal and the number
claimed is 10 or less, you do not need to
complete Form W-4MN. Your employer
will use the same number as on your federal
Form W-4 to determine the amount of Min-
nesota income tax to withhold.
You must complete Form W-4MN and
provide it to your employer, if you:
• choose to claim fewer Minnesota allow-
ances than for federal purposes (Min-
nesota allowances cannot exceed the
number of federal allowances);
• claim more than 10 Minnesota allow-
Your employer is required to
provide copies of your completed Form
W-4MN to the department);
• request additional Minnesota withhold-
ing be deducted each pay period; or
• claim to be exempt from Minnesota in-
come tax withholding and you reasonably
expect your wages to exceed $200 per
(see Section 2 instructions)
Consider completing a new Form W-4MN
whenever your personal or fi nancial situa-
tion changes. If you have not had suffi cient
income tax withheld from your wages, inter-
est and/or penalty charges may be assessed
when you fi le your individual income tax
An employee who submits a false Form
W-4MN may be subject to a $500 penalty.
Section 1 — Minnesota Allowances
Do not claim more than the correct number
of allowances. If you claim every allow-
ance to which you are entitled and you still
expect to owe more income tax for the year
than will be withheld, you may:
• increase your withholding by claiming
fewer allowances; or
• enter into an agreement with your em-
ployer to have additional amounts with-
(see line 3 instructions)
Line 3. If you claim no Minnesota allow-
ances on line 2, and you still expect to have
a balance due on your tax return for the
year, you may ask your employer to with-
hold an additional amount of tax each pay
period. If your employer agrees, enter the
additional amount you want withheld from
each paycheck on line 3.
Section 2 — Minnesota Exemption
If you are exempt from Minnesota with-
holding, your employer will not withhold
Minnesota income tax from your pay. To
claim exemption, you must meet one of the
• You meet the federal requirements; you
claim exempt from federal withholding
on Form W-4 and you also want to claim
exempt from Minnesota withholding; you
had no Minnesota income tax liability in
the prior year; you received a full refund
of Minnesota tax withheld; and you
expect to have no Minnesota income tax
liability for the current year. OR
• You qualify as exempt from Minnesota
withholding under the Soldiers and
Sailors Civil Relief Act. To qualify, you
must be the spouse of a military mem-
ber assigned to duty in Minnesota, be
domiciled in another state and be present
in Minnesota solely to be with your active
duty military member spouse. OR
If you are claiming the same number of Minnesota allowances as federal and the number claimed is 10 or less,
there is no need for you to complete this form.
• You are a member of an American Indian
tribe living and working on the reserva-
tion of which you are an enrolled member.
• Your wages are for Minnesota National
Guard (MNG) pay or for active duty U.S.
military pay. MNG and active duty U.S.
military members can claim exempt from
Minnesota withholding on these wages,
even if taxable federally. Visit our website
to view Income Tax Fact Sheet #5 for fur-
ther tax information regarding military
In order to avoid owing tax at the end
of the year, you may not want to claim ex-
empt if you (and/or your spouse when fi ling
a joint return) expect to have other forms of
income subject to Minnesota tax.
If you claim exempt from Minnesota with-
holding, you must provide your employer
with a new Form W-4MN by February 15th
of each year. If your wages are expected to
exceed $200 per week, your employer is re-
quired to furnish a copy to the department.
If another person can claim you as a depen-
dent on his or her federal tax return, you
cannot claim exempt from Minnesota with-
holding if your annual income exceeds $950
and includes more than $300 of unearned
Use of Information
All information on Form W-4MN is
private by state law. It cannot be given
to others without your consent, except
to the Internal Revenue Service and to
other states that guarantee the same
privacy. Your name, address and Social
Security number are required for
identifi cation. Information about your
allowances is required to determine
your correct tax. We ask for your phone
number so we can call you if we have a
Form W-4MN Instructions
All new employees must complete federal
Form W-4 when they fi rst begin work for
you. If the employee claims the same num-
ber of Minnesota allowances as federal, does
not request additional Minnesota with-
holding be deducted or claims exempt from
Minnesota withholding, there is no need for
the employee to complete Form W-4MN.
When determining Minnesota withhold-
ing, use the same number of allowances the
employee listed on Form W-4.
If the employee does not give you a com-
pleted Form W-4 or Form W-4MN before
the fi rst wage payment, withhold Min-
nesota tax as if the employee is single with
zero withholding allowances. You are not
required to verify the number of allowances
claimed by each employee.
You should honor each Form W-4MN you
receive unless we notify you otherwise or if
the employee claims more Minnesota than
federal allowances. If the employee claims
more Minnesota than federal allowances,
use the number of federal allowances to
determine the Minnesota withholding
For more information, see
When to Com-
. Keep all
forms in your records.
If your employee claims exempt from Min-
nesota withholding, they must provide you
with a new Form W-4MN by Feb. 15 of each
year. Exempt forms received during the year
must be submitted to the department within
30 days of receipt from the employee.
When to Send Copies
You must send copies of Form W-4MN to
the department if the employee:
• claims more than 10 Minnesota with-
holding allowances; or
• claims to be exempt from Minnesota
withholding and you reasonably expect
the employee’s wages to exceed $200
per week (
If the employee is
a resident of a reciprocity state and has
completed Form MWR); or
• you believe the employee is not entitled to
the number of allowances claimed.
If the employee is only asking to have
additional Minnesota withholding to be de-
ducted, there is no need to submit the Form
W-4MN to the department.
A $50 penalty may be assessed for each
required Form W-4MN not fi led with the
Invalid Forms W-4MN
Th e following situations make the Form
• any unauthorized change or addition to
the form, including any change to the lan-
guage certifying the form is correct;
• if, by the date an employee gives it to
you, he or she indicates in any way the
form is false;
• the form is incomplete or lacks the neces-
• both Section 1 AND Section 2 were com-
• the employer information is incomplete.
If you receive an invalid form, do not use
it to fi gure Minnesota income tax with-
holding. Tell the employee it is invalid and
they must complete and submit a new one.
If the employee does not give you a valid
one, withhold taxes as if the employee was
single and claiming zero withholding al-
lowances. However, if you have an earlier
Form W-4MN for this worker that is valid,
withhold as you did before.