2020 Minnesota W4 Form - NEMT Connect

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Last name	Schilling
First name and middle initial	Kurt
Single; Married, but legally separated; or Spouse is a nonresident alien	Checked
Married (filing jointly)	No
Married, but withhold at a higher Single rate	No
Will you fill out Section 1 and not Section 2?	Checked
A) Enter “1” for yourself if no one else can claim you as a dependent	1
B) Enter “1” if any of the following apply: You are single and have only one job; You are married, have only one job, and your spouse does not work; Your wages from a second job or your spouse’s wages are $1500 or less	1
C) Enter “1” for your spouse. You may choose to enter “0” if you are married and have either a working spouse or more than one job.	0
E) Enter “1” if you will file as Head of Household	0
D) Enter the number of dependents (other than your spouse or yourself) you will claim on your tax return	0
F) Total number of allowances claimed. Add steps A through E.	2
Will you fill out Section 2 and not Section 1?	No
A) I meet the requirements and claim exempt from both federal and Minnesota income tax withholding.
B) Even though I did not claim exempt from federal withholding, I claim exempt from Minnesota withholding, because of all of the following: I had no Minnesota income tax liability this year; I received a refund of all Minnesota income tax withheld; I expect to have no Minnesota income tax liability this year
C) All of the following are true:: My spouse is a military service member assigned to a military location in Minnesota; My domicile (legal residence) is in another state; I am in Minnesota solely to be with my spouse.
If you answered 'Yes' to C), what is your State of Domicile?
D) I am an American Indian that resides and works on a reservation.
E) I am a member of the Minnesota National Guard or an active duty U.S. military member and claim exempt from Minnesota withholding on my military pay.
F) I receive a military pension or other military retirement pay as calculated under U.S. Code, title 10, sections 1401 through 1414, 1447 through 1455, and 12733 and I claim exempt from Minnesota withholding on this retirement pay.
1) Minnesota Allowances: Enter Step F from Section 1 above or Step 10 of the Itemized Deductions Worksheet	2
2) Additional Minnesota withholding you want deducted each pay period (see instructions)
Signature (Required)
Today's Date	12/26/2020