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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 8, 
2020: Section 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 his or her 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. 7-20)                                                                                     Wisconsin Department of Revenue