Form W-4DE Fillable Withholding Exemption Certificate for Military Spouse
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (and sign below) (checkbox) Unchecked (City) (Date) (Delaware tax withheld note the start date here and sign below) (Employee Name) (Employee Social Security Number) (Employer s Name) (homestead status; the location of permanent home; mailing address; amount of time spent in a state ) (If yes give name of State of Domicile) (Military Servicemember Spouse s Name) (Name of Military Servicemember s Station) (Print the Form ) Print Form (Reset the Form) Reset (Revised 01/25/10) (Spouse s Social Security Number) (State) (Street address where you both currently reside) (Telephone Number) (Zip code) a new domicile in another state A person s permanent residence once established continues as their State of Domicile until they take steps to establish A representative of Employer with responsibility for Personnel matters must certify that you have completed the Affiliations: amount of time spent in a state and sign below; Annual Withholding Tax Exemption Certification Box 8995 Wilmington Delaware 19801 8995 or telephone (302) 577 8200 by the Military Spouses Residency Relief Act (P L 111 97) City State Zip code CRITERIA USED TO DETERMINE DOMICILE Date Phone Number Delaware (check one) YES Delaware tax withheld note the start date here and sign below; Delaware withholding tax because you meet these conditions DOMICILE Domicile is a place where a person has established permanent residence with an intention to dwell in that place domicile only when one establishes a new domicile In order to change domicile one normally has to be a resident of that Employee Name Employee s Signature Employee Social Security Number Employer s Name Employer s Signature Date Employers are not exempt from withholding tax liability for failing to withhold the proper Delaware tax on any Employee ensure that the ID denotes the Employee as a current Military Spouse and retain a copy with the Employees ensure the Employee s military spouse s LES assignment location matches the location the Employee indicated Family and Dependents: return and that person s state of residence; Financial Data: for Military Spouse for Military Spouse by completing the employer s section at the bottom of that form FORM W 4DE is to be used only for Employees claiming exemption from Delaware s Income Tax Withholding forth under the Servicemembers Civil Relief Act as amended by the Military Spouses Residency Relief Act (P L 111 97) Give the certificate to your Employer Keep a copy for your records Higher Education: where taxpayer qualifies for in state tuition homestead status; I am NOT a military servicemember (check one) YES NO ID that is dated more than four years before the date on which it is given to the Employer If yes give name of State of Domicile In order to claim domicile in a state other than the state in which you currently reside you must have proof that you meet In order to qualify you must complete this form in full meet all the conditions below and certify that you are not subject to Licenses and Registrations: location of bank accounts; location of fraternal social or athletic memberships; mailing address; Military Servicemember Spouse s Name Military Spouse Residency Exemption the Employer must contact the Division of Revenue immediately at P O My domicile is a state other than Delaware (check one) YES My military servicemember spouse has current military orders assigning him or her to a military location near My spouse is a military servicemember (check one) YES NO Name of Military Servicemember s Station new state for at least six months The domicile is created based on performing one or more of the following actions No single factor determines a person s State of Domicile; all factors must be evaluated together Some factors such as NOTICE TO EMPLOYERS on the Form W 4DE and is within the four state area of DE; PA; NJ or MD one or more of the criteria listed below If you previously were not a domiciliary of another state you can not claim that permanently and to return to it after absence One has only one state of domicile at any time and loses one s current personnel records These IDs are reissued every four years; accordingly the Employer may not accept a Military place of worship Property Ownership and Residence: Read the instructions before completing this form Except for signature you must print records If the Employer believes the Employee has claimed too many exemptions or improperly claimed the requirements because they meet the conditions set forth under the Servicemembers Civil Relief Act as amended REQUIREMENTS OF EMPLOYER SINGLE DOMICILE FACTOR NOT SUFFICIENT Spouse s Social Security Number Start Exemption Check here if you answered YES to ALL of the above questions note the start date here state as your domicile merely by making an election state driver s license; State of Delaware Form W 4DE Division of Revenue state where prior resident tax returns were filed; state where professional licenses are maintained state where vehicles are registered; state where wages are earned Statement (LES) The Employer must retain a copy with the Employees personnel records The Employer must Street address where you both currently reside Terminate Exemption Check here if the answer to one of four questions above is NO to start having the Employee The Employee must show the Employer an original of his or her military spouse s latest Leave and Earning The Employee must show the Employer an original of the Employee s current Military ID The Employer must The Employer must keep the Delaware withholding tax exemption certificate with the Employee s personnel The following is a summary of the criteria used to determine State of Domicile : the location of permanent home; three requirements of the employer above by certifying the employee s Withholding Tax Exemption Certification Under penalties of perjury I certify that I am not subject to Delaware withholding tax because l meet the conditions set union membership location; unless they have a Federal Form W 4 and if applicable a Delaware Form W 4DE that is fully completed and signed by where a person makes his or her charitable contributions play no part in domiciliary determination at all where taxpayer is registered to vote; where taxpayer qualifies for unemployment benefits; where taxpayer s spouse and dependents reside