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Mississippi Form 89-350

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Mississippi Form 89-350
Mississippi Form 89-350
Form 89-350-10-2 Rev.1/10
Department of Revenue
P.O. Box 960
Jackson Mississippi 39205
IMPORTANT: THIS CERTIFICATE MAY BE USED FOR PAY PERIODS IN CALENDAR YEAR 2010 and after
Employee's Name
SSN
Employee's Residence Address
Number and Street City or Town State Zip Code
EMPLOYEE:
File this form with
your employer.
Otherwise, he must
withhold Mississippi
income tax from the
full amount of your
wages.
EMPLOYER:
Keep this certificate
with your records. If
the employee is
believed to have
claimed excess
exemption, the
Department of Revenue
should be advised.
CLAIM YOUR WITHHOLDING PERSONAL EXEMPTION
Marital Status
1.Single
2.Married
(Check
One)
Personal Exemption Allowed
( )Enter $6,000 as exemption................................
Amount Claimed
$
(a)
(b)
( )Spouse IS employed: Enter that part of $12,000 claimed by
you, in multiples of $500. See instructions 2(b)below.......
( )Spouse NOT employed:Enter$12,000.........................
Head of
Family
4. Dependents
Number Claimed
( )Enter $9,500 as exemption. To qualify as head of family,
you must be single and have a dependent living in the home
with you. See instructions 2(c) & (d)
below.......................................................
You may claim $1,500 for each dependent,* other than for
taxpayer and spouse, who receives chief support from you and
who qualifies as a dependent for Federal income tax purposes.
*A head of family may claim $1,500 for each dependent
excluding the one which qualifies you as head of family.
Multiply number of dependents claimed by you by $1,500. Enter
amount claimed..............................................
5. Age and
Blindness
Exemption
Age 65 or older ( )Husband ( )Wife ( ) Single
Blind ( )Husband ( )Wife ( ) Single
Multiply number of blocks checked by $1,500. Enter amount
claimed.....................................................
Note: No exemption allowed for age or blindness for
dependents.
Effective only for
pay periods in 2000
and after
6. TOTAL AMOUNT OF EXEMPTION CLAIMED - Lines 1 through 5....................
I declare under the penalties imposed for filing false reports that the amount of exemption claimed on this certificate does
not exceed the amount to which I am entitled or I am entitled to claim exempt status.
Date:Employee's Signature:
$
7. Additional dollar amount withholding per pay period if agreed to by
your employer............................................................
INSTRUCTIONS
$
1.THE PERSONAL EXEMPTIONS ALLOWED ARE:
(a) Single individuals - $6,000
(b) Married individuals (jointly) - $12,000
(c) Head of family- $9,500
(d) Dependents - $1,500
(e) Aged 65 and over - $1,500
(f) Blindness -$1,500
2.CLAIMING PERSONAL EXEMPTIONS:
(a) SINGLEINDIVIDUALS enter $6,000 on Line 1.
(b) MARRIED INDIVIDUALS are allowed a joint exemption of $12,000.
If the spouse is not employed, enter $12,000 onLine 2(a). Ifthe spouse
is employed, the exemptionof $12,000 may be divided between
taxpayer and spouse inanymanner theychoose -inmultiples of$500. For
example - taxpayer mayclaim $6,500 and spouse claims $5,500; or
taxpayer mayclaim $8,000 andspouse claims $4,000.The total claimed
bytaxpayer and spouse maynot ex- ceed $12,000.Enter amount claimed
byyouonLine 2(b).
(c) AHEAD OF FAMILY is a single individual who maintains a home which
is the principal place ofabode for himself and at least one dependent.
Single individuals qualifyingas a head of family enter $9,500 onLine
3.If the taxpayer has more thanone dependent, additional exemptions
are applicable.See item(d).
(d) An additional exemptionof$1,500 maygenerallybe claimed for each
dependent of the taxpayer.A dependent is anyrelative who receives
chiefsupport from the taxpayer and who qualifies as a dependent for
Federal income taxpurposes. Head of familyindividuals mayclaiman
additional exemption for eachdependent excluding the one whichis
required for head of family status.For example, a head offamilytax-
payer has 2 dependent childrenand his dependent mother livingwith
him. The taxpayer mayclaim 2 additional exemptions. Married or single
individuals may claimanadditional exemption for eachdependent, but
should not include themselves or their spouse. Married taxpayers may
divide the number of their dependents betweentheminany manner
they choose; for example, a married couple has 3 children who qualify
as dependents. The taxpayer mayclaim 2 dependents and the spouse 1;
or the taxpayer 3 and the spouse none. Enter the amount ofdependent
exemptionon line 4.
(e) Anadditional exemptionof $1,500 maybe claimed byeither taxpayer
or spouse or bothifeither or bothhave reached the AGE of 65 before the
close of the taxable year. No additional exemptionis authorized for
dependents byreasonofage. Check applicable blocks onLine 5.
(f) An additional exemptionof$1,500 maybe claimed by either taxpayer
or spouse or bothifeither or bothare BLIND.No additional exemptionis
authorized for dependents byreasonof blindness.Check applicable
blocks on Line 5. Multiply number ofblocks checked onLine 5 by
$1,500 and enter amount of exemptionclaimed.
3.TOTAL EXEMPTION CLAIMED:
Add the amount ofexemptions claimed ineachcategory and enter the
total onLine 6. This amount will be used as a basis for withholdingincome
taxunder the appropriate withholdingtables.
4.A NEW EXEMPTION CERTIFICATE MUST BE FILED WITH YOUR
EMPLOYER WITHIN 30 DAYS AFTER ANYCHANGEIN YOUR
EXEMPTION STATUS.
5.PENALTIES ARE IMPOSED FOR WILLFULLY SUPPLYING FALSE
INFORMATION OR WILLFULFAILURETOSUPPLYINFORMATION
WHICH WOULD REDUCE THEWITHHOLDING EXEMPTION.
6.IF THEEMPLOYEEFAILS TO FILE AN EXEMPTION CERTIFICATE
WITH HIS EMPLOYER, INCOME TAX MUST BE WITHHELD BY THE
EMPLOYER ON TOTAL WAGES WITHOUT THE BENEFIT OF
EXEMPTION.
7.IMPORTANT: USE THIS FORM ONLY FOR PAY PERIODS IN 2000
AND AFTER.
8.To comply with the MilitarySpouses ResidencyRelief Act (PL 111-97)
Signed into law November 11, 2009.
s s s s s s s
s
MISSISSIPPI EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE
3.
SSN
If you meet the conditions set forth under the Service Member Civil Relief,
as amended by the Military Spouses Residency Relief Act and have no
Mississippi tax liability, write "Exempt" on line 8. You must attach a copy
of the Federal Form DD-2058 and a copy of your Military Spouse ID Card to
this form so your employer can validate the exemption claim......
Military Spouses
Residency Relief Act
Exemption from
Mississippi
Withholding
8.
s
$
$
$
$
$
Mississippi Form 89-350