05 02 11
Boise ID 83722 0036
Daytime phone
EFO00226
Employee do not write in Employer Section below
Employee signature
EMPLOYEE'S IDAHO MILITARY SPOUSE WITHHOLDING
Employer please keep a copy of this document for your records and send a copy within 30 days from the date the employee signs the form to:
Employer Section
Employer signature
EXEMPTION CERTIFICATE
I am domiciled (a permanent resident) in (state of domicile) and
I am the spouse of a service member on active duty stationed in Idaho on official orders and
I claim an exemption from Idaho withholding based on the following facts:
I have the same domicile as my servicemember spouse
ID MS1
Idaho State Tax Commission
Note: All three conditions must be met to qualify for the exemption from Idaho withholding
Note: Federal law prohibits photocopying any military identification card except to obtain health care
PO Box 36
Print full name
Social Security Number
State
Street address
Tax Discovery Bureau
This exemption is valid through December 31 2012 A new Form ID MS1 is required each year
Under penalties of perjury I declare that to the best of my knowledge and belief this form is true correct and complete
Zip Code
