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                        Nonresident Employee's Withholding Reciprocity Declaration
                                                (To be filed with your Wisconsin employer)

Employee’s Name (first name, middle initial & last name) Social Security Number
                                                                                  I declare that while working in 
                                                                                  Wisconsin I am a legal resident of:
Employee’s Home Address (number and street)                                               Illinois  Kentucky
                                                                                          Indiana   Michigan
City or Post Office                                      State Zip Code        Employee’s Signature               Date

                                                         Applicable Laws and Rules

This document provides statements or interpretations of the following laws and regulations in effect as of July 5, 
2022: sec. 71.64(8)(a), Wis. Stats., and sec. Tax 2.02, Wis. Adm. Code.

NOTE:  THIS DECLARATION MAY ONLY BE USED BY A NONRESIDENT WORKING IN WISCONSIN WHO IS A 
LEGAL RESIDENT OF ILLINOIS, INDIANA, KENTUCKY, OR MICHIGAN.

Reciprocal agreements Wisconsin has with Illinois, Indiana, Kentucky, and Michigan exempt legal residents of those states 
from Wisconsin income taxes on compensation (e.g., wages, fees, commissions) earned for personal services performed 
in Wisconsin.

A  nonresident  employee  qualifying  for  this  exemption  must  complete  and  file  this  declaration  with  their  employer 
as  authorization  for  the  employer  to  stop  the  withholding  of  Wisconsin  income  taxes.  If  the  employer  has  withheld 
Wisconsin  income  taxes  while  the  employee  qualifies  for  the  exemption,  the  employee  must  file  a  Wisconsin 
income  tax  return  (Form 1NPR),  during  the  regular  filing  season,  requesting  a  refund  of  those  income  taxes.

W-220 (R. 7-22)                                                                                     Wisconsin Department of Revenue