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Form 89-350-22-8-1-000 (Rev. 10/22)
MISSISSIPPI EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE
Employee's Name SSN
Employee's Residence
Number and Street City or Town State Zip Code
CLAIM YOUR WITHHOLDING PERSONAL EXEMPTION
Marital Status Personal Exemption Allowed Amount Claimed
EMPLOYEE: 1. Single Enter $6,000 as exemption . . . . ► $
File this form with your (a) Spouse NOT employed: Enter $12,000 ► $
employer. Otherwise, you 2. Marital Status
must withhold Mississippi (Check One) Spouse IS employed: Enter that part of
income tax from the full (b) $12,000 claimed by you in multiples of
amount of your wages. $500. See instructions 2(b) below. ► $
Enter $9,500 as exemption. To qualify
as head of family, you must be single
3. Head of Family and have a dependent living in the
home with you. See instructions 2(c)
and 2(d)below . . . . . . . . . . . . ► $
EMPLOYER: You may claim $1,500 for each dependent ,*other than
Keep this certificate with for taxpayer and spouse, who receives chief support
from you and who qualifies as a dependent for Federal
your records. If the 4. Dependents income tax purposes.
employee is believed to Number Claimed * A head of family may claim $1,500 for each
have claimed excess dependent excluding the one which qualifies you
exemption, the Department as head of family. Multiply number of dependents
of Revenue should be claimed by you by $1,500. Enter amount claimed . . . ► $
advised.
• Age 65 or older Husband Wife Single
5. Age and • Blind Husband Wife Single
blindness
Multiply the number of blocks checked by $1,500.
Enter the amount claimed . . . . . ► $
* Note: No exemption allowed for age or
blindness for dependents.
6. TOTAL AMOUNT OF EXEMPTION CLAIMED - Lines 1 through 5... ►
$
7. Additional dollar amount of withholding per pay period if $
agreed to by your employer . . . . . . . . . . . . . . . ►
Military Spouses 8. If you meet the conditions set forth under the Service Member
Residency Relief Act Civil Relief, as amended by the Military Spouses Residency
Exemption from Mississippi Relief Act, and have no Mississippi tax liability, write
Withholding "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.. ►
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.
Employee's Signature: Date:
INSTRUCTIONS
1. The personal exemptions allowed: should not include themselves or their spouse. Married taxpayers may divide the number of their
(a) Single Individuals $6,000 (d) Dependents $1,500 dependents between them in any manner they choose; for example, a married couple has 3 children
(b) Married Individuals (Jointly) $12,000 (e) Age 65 and Over $1,500 who qualify as dependents. The taxpayer may claim 2 dependents and the spouse 1; or the taxpayer
(c) Head of family $9,500 (f) Blindness $1,500 may claim 3 dependents and the spouse none. Enter the amount of dependent exemption on Line 4.
2. Claiming personal exemptions: (e) An additional exemption of $1,500 may be claimed by either taxpayer or spouse or both if
(a) Single Individuals enter $6,000 on Line 1. either or both have reached the age of 65 before the close of the taxable year. No
additional exemption is authorized for dependents by reason of age. Check applicable
(b) Married individuals are allowed a joint exemption of $12,000. blocks on Line 5.
If the spouse is not employed, enter $12,000 on Line 2(a). If the spouse is employed, the (f) An additional exemption of $1,500 may be claimed by either taxpayer or spouse or both if
exemption of $12,000 may be divided between taxpayer and spouse in any manner they either or both are blind. No additional exemption is authorized for dependents by reason of
choose - in multiples of $500. For example, the taxpayer may claim $6,500 and the spouse blindness. Check applicable blocks on Line 5. Multiply number of blocks checked on Line 5
claims $5,500; or the taxpayer may claim $8,000 and the spouse claims $4,000. The total by $1,500 and enter amount of exemption claimed.
claimed by the taxpayer and spouse may not exceed $12,000. Enter amount claimed by 3. Total Exemption Claimed:
you on Line 2(b). Add the amount of exemptions claimed in each category and enter the total on Line 6. This
(c) Head of Family amount will be used as a basis for withholding income tax under the appropriate withholding
tables.
A head of family is a single individual who maintains a home which is the principal place of
abode for himself and at least one other dependent. Single individuals qualifying as a head 4.A NEW EXEMPTION CERTIFICATE MUST BE FILED WITH YOUR EMPLOYER
of family enter $9,500 on Line 3. If the taxpayer has more than one dependent, additional WITHIN 30 DAYS AFTER ANY CHANGE IN YOUR EXEMPTION STATUS.
exemptions are applicable. See item (d).
(d) An additional exemption of $1,500 may generally be claimed for each dependent of the 5. PENALTIES ARE IMPOSED FOR WILLFULLY SUPPLYING FALSE INFORMATION.
taxpayer. A dependent is any relative who receives chief support from the taxpayer and who
q qualifies as a deppendent for Federal income tax ppurpposes. Head of family individuals may 6. IF THE EMPLOYEE FAILS TO FILE AN EXEMPTION CERTIFICATE WITH HIS
claim an additional exemption for each dependent excluding the one which is required for EMPLOYER, INCOME TAX MUST BE WITHHELD BY THE EMPLOYER ON TOTAL
head of family status. For example, a head of family taxpayer has 2 dependent children and WAGES WITHOUT THE BENIFIT OF EXEMPTION.
his dependent mother living with him. The taxpayer may claim 2 additional exemptions. To comply with the Military Spouse Residency Relief Act (PL111-97) signed on November 11, 2009.
Married or single individuals may claim an additional exemption for each dependent, but