Form NDW-M Exemption from withholding for a qualifying spouse of a U.S. armed forces servicemember

Domicile refers to your residence by law and is also referred to as your legal residence It is the place that is your permanent home and is the place to which you always intend to return whenever you are absent from it Domicile is based on your intent and actions which must be consistent The Servicemembers Civil Relief Act provides that the domicile of a Employer identification number (EIN) I am married to an active duty member of the U S armed forces I am not a member of the U S armed forces I am residing and working in North Dakota only because I want to be with my military spouse Military spouse's state of domicile (legal residence) My military spouse and I are domiciled in a state other than North Dakota My military spouse's permanent duty station is in North Dakota Phone number Social security number State State of domicile (legal residence) while he or she is stationed in North Dakota Zip code (1) the date you give it to your employer or (2) the rst payroll period your employer is able to put the exemption into effect The exemption does not apply to wages paid prior to the date Form NDW M takes effect (701) 328 1248 Or send an e mail to (Revised 01/10) 1 For each of the following statements indicate whether it applies to you If it applies check "YES " If it does not apply check "NO " If you check "NO" to any of the statements you are not eligible for the withholding exemption A change in the servicemember s permanent duty station to a location outside North Dakota Address An employee whose wages are exempt from North Dakota income tax because of the Act may use Form NDW M to apply for exemption from North Dakota income tax withholding An exception to the requirement to withhold North Dakota income tax applies if an employee completes and gives to you a Form NDW M This exception applies only if you have a Form NDW M on le for the employee; it is not enough that the employee is eligible for the exemption under the Act Annual renewal are lled in and a copy of the ATTACH A COPY OF YOUR DEPENDENT MILITARY ID CARD ISSUED BY THE U S DEPT OF DEFENSE card is attached If not return the Change in domicile to North Dakota by either spouse; or Check to see that all items in Part 1 Completing Form NDW M Death of the servicemember; Divorce from the servicemember; Domicile outside North Dakota Eligibility Employee information Name (First MI Last) employee s dependent military ID Employee See "Instructions for employee" for eligibility requirements and other information Employee's signature Date signed Employer name Employer See "Instructions for employer" for the purpose and proper handling of this form Fill in Part 2; Form NDW M exemption Form NDW M is valid only for the calendar year for which it is completed Provided you are still eligible you must le a new Form NDW M for each subsequent year you want to continue the exemption from North Dakota withholding Form NDW M takes effect on the later of Form North Dakota Office of State Tax Commissioner form to the employee; Give the completed Form NDW M with attached copy of military ID card to your employer I declare under penalty of perjury that the wages I earn for my services performed in North Dakota are exempt from North Dakota income tax because I meet the conditions of the Military Spouses Residency Relief Act (P L 111 97) and the information I provided on this form is accurate to the best of my knowledge and belief If an employee gives you a completed Form NDW M do the following: If you are a civilian spouse of an active duty U S armed forces servicemember you may complete Form NDW M if you meet all of the following conditions: If you checked "YES" to ALL of the statements in item 1 provide the following information for you (the employee) and your military spouse All boxes must be filled in to be valid If you have questions about this form call the Withholding Tax Section at If you meet all of the eligibility requirements for the exemption from withholding ll in the last two digits of the calendar year in the upper right hand corner then ll out Items 1 through 3 of Part 1 Attach a copy of your dependent military ID card to Form NDW M and give them to your employer Instructions for employee Instructions for employer Instructions to Form NDW M Keep the original signed Form NDW M and the attached copy of the military ID card for your payroll records; it relieves you of your obligation to withhold North Dakota income tax and you shall be held harmless from liability for withholding based on the employee s representations on the form; and Mail a copy of the completed Form NDW M and attached military ID card to: Attn: Withholding Tax Section Of ce of State Tax Commissioner 600 E Blvd Ave Dept 127 Bismarck ND 58505 0599 Military spouse information Name (First MI Last) Military spouse's permanent duty station NDW M Exemption from withholding for a qualifying For Calendar Year spouse of a U S armed forces servicemember 20 North Dakota income tax law requires you to withhold North Dakota income tax from wages paid to an employee if the employee performs services within North Dakota and the wages are subject to federal income tax withholding Note: An employer shall be held harmless from liability for withholding based on the employee's representations on this form Noti cation of ineligibility Notify your employer if you become ineligible for this exemption see instructions OffOff OffOff OffOff Or fax it to the Withholding Tax Section at (701) 328 1942 Part 1 To be completed by the employee Part 2 To be completed by the employer Privacy Act information In compliance with the Federal Privacy Act of 1974 Public Law 93 579 the disclosure of a social security number or a federal employer identification number (EIN) on this form is mandatory and is required under N D C C 57 38 56 A social security number or federal employer identification number is used as an identification number by the Office of State Tax Commissioner for file control purposes recordkeeping and for cross checking the taxpayer's files with the Internal Revenue Service Purpose of form Questions Requirement to withhold See "Instructions for employer" for the proper handling of this form Street address where currently residing The Military Spouses Residency Relief Act ( Act ) (P L 111 97) is federal legislation that was signed into law on November 11 2009 This Act amended the Servicemembers Civil Relief Act to provide a number of bene ts to civilian spouses of active duty U S armed forces servicemembers If certain conditions are met one of the bene ts exempts a civilian spouse s compensation received for working in the state where the servicemember spouse is stationed U S armed forces servicemember does not change based only on the servicemember s presence in a state in compliance with military orders The Military Spouses Residency Relief Act provides that a civilian spouse s domicile does not change based only on the civilian spouse s presence in a state to be with the servicemember What you must do When the withholding exemption takes effect withhold@nd gov YES NO You and your servicemember spouse maintain domicile in a state other than North Dakota This applies even if you have different states of domicile See Domicile outside North Dakota below; You are in North Dakota only because you want to be with your service member spouse who is stationed in North Dakota You must complete a new Form NDW M each year to maintain the exemption see instructions You must notify your employer to begin the withholding of North Dakota income tax from your wages if you become ineligible for the exemption This would occur in the following cases: Your servicemember spouse s permanent duty station is in North Dakota; and