MW-4                                                               CITY OF MUSKEGON                                                              n Non-Resident                n City Resident
                                                      EMPLOYEE’S WITHHOLDING CERTIFICATE
1. Print Full Name                                                 Social Security No.                Office, Plant, Dept.                       Employee Identification No.
2. Address, Number and Street                                      City, Township or Village where you reside                                    State                         Zip Code
3. Predominant Place of Employment           Non-Resident City                                                Under
Print name of each city where you work for                                                                    25%                  40%                  60%                  80%                  100%
this employer and circle closest %                            City                                            Under
of total earnings in each                                                                                     25%                  40%                  60%                  80%                  100%
YOUR WITHHOLDING              Check          4. Exemption for      Regular $600              Additional $600 exemption                           Enter number of
EXEMPTIONS:                   boxes          yourself            n exemption     n if 65 or over at end of year                                  exemptions checked
(See instructions             which          5. Exemption for      Regular $600              Additional $600 exemption                           Enter number of
on reverse side)                   apply     your wife (husband) n exemption     n if 65 or over at end of year                                  exemptions checked
                                             6. (a) Exemptions for your children Number      6. (b) Exemptions for your    Number                  Enter total of line 6
EMPLOYEE: File this form with your employ-                                                    other dependents                                     (a plus b)
er.  Otherwise  he  must  withhold  CITY OF  7. Add the number of exemptions which you have claimed on lines 4, 5 and 6 above and write the total
MUSKEGON income tax from your earnings
without exemption.                           8. Additional amount you want deducted from each pay (if employer agrees)                                                           $             .00
EMPLOYER: Keep this certificate with your
records. If the information submitted by the I certify that the information submitted on this certificate is true, correct and complete to the best of my knowledge and belief.
employee is not believed to be true, correct
and complete the form, and the CITY must     9. Date                                         Signature
be so advised.

LINE 3 INSTRUCTIONS - If you work for this employer in more than two cities or                        CHANGES IN EXEMPTIONS - You should file a new certificate at any time
communities, print names of the two Michigan cities or communities where you perform                  if the number of your exemptions INCREASES.
the greatest percent of your work. Circle the closest percent of total earnings for work              You must file a new certificate within 10 days if the number of 
done or services rendered in each city or community listed. The estimated percent of                  exemptions previously claimed by you DECREASES for any of the following 
total earnings from this employer for work done or services performed within taxing                   reasons:
cities (line 3 on other side) is for withholding purposes only. In determining final tax lia-         (a) Your wife (or husband) for whom you have been claiming exemption is 
bility this estimate is subject to substantiation and audit.                                          divorced or legally separated, or claims her (or his) own exemption on a
DEPENDENTS - To qualify as your dependent (line 6 on other side) a person (a) must                    separate certificate.
receive more than one-half of his or her support from you for the year, and (b) must have             (b)The support of a dependent for whom you claimed exemption is taken 
less than $600 gross income during the year (except your child who is a student or who                over by someone else, so that you no longer expect to furnish more 
is under 19 years of age), and (c) must not be claimed as an exemption by such person’s               than half the support for the year.
husband or wife, and (d) must be a citizen or resident of the United States or a resident             (c) You find that a dependent for whom you claimed exemption will receive
of Canada, Mexico, the Republic of Panama or the Canal Zone (this does not apply to an                $600 or more of income of his own during the year (except your child 
alien child legally adopted by and living with a United States citizen abroad), and (e) must          who is a student who is under 19 years of age).
(1) have your home as his principal residence and be a member of your household for                   OTHER  DECREASES  in  exemption,  such  as  the  death  of  a  wife  or  a
the entire year, or (2) be related to you as follows:                                                 dependent, do not affect your withholding until the next year, but require the
Your son or daughter (including legally adopted children), grandchild, stepson,                       filing of a new certificate by December 1 of the year in which they occur.
stepdaughter, son-in-law or daughter-in-law;                                                          CHANGE OF RESIDENCE - You must file a new certificate within 10 days
Your father, mother, grandparent, stepfather, stepmother, father-in-law, or mother-in law;            after you change your residence from or to a taxing city.
Your brother, sister, stepbrother, stepsister, half brother, half sister, brother-in-law, or          CHANGES  IN  EMPLOYMENT  -  You  must  file  a  new  certificate  by
sister-in-law;                                                                                        December 1 of each year if your Line 3 estimate of the percent of work done
Your uncle, aunt, nephew, or niece (but only if related by blood).                                    or services to be rendered in cities levying an income tax will change for the
                                                                                                      ensuing year.