1. ALLOWANCE FOR YOURSELF:Enter1foryourselfifyourfilingstatus issingle,married,ORheadofhousehold.............................................................................................................................................. 12. ALLOWANCE FOR YOUR SPOUSE: Doesyourspousework? Yes No IfYES,enter0.IfNO,enter1foryourspouse..................................................................................................................................... 23. ALLOWANCE FOR DEPENDENTS: Enterthenumberofdependentsyouwillclaimonyourtaxreturn.Donotclaim yourselforyourspouseordependentsthatyourspousehasalreadyclaimedonhisorherFormMOW-4....................................... 3

4. ADDITIONAL ALLOWANCES: Youmayclaimadditionalallowancesifyouitemizeyourdeductions orhaveotherstatetaxdeductionsorcreditsthatloweryourtax.Enterthenumberofadditional allowancesyouwouldliketoclaim........................................................................................................................................................ 45. TOTAL NUMBER OF ALLOWANCES YOU ARE CLAIMING:AddLines1through4andentertotalhere...................................... 56. ADDITIONAL WITHHOLDING:Ifyouexpecttohaveabalancedue(asaresultofinterestincome,dividends,incomefroma part-timejob,etc.)onyourtaxreturn,youmayrequestyouremployertowithholdanadditionalamountoftaxfromeach payperiod.Tocalculatetheamountneeded,dividetheamountoftheexpectedbalanceduebythenumberofpayperiods inayear.Entertheadditionalamounttobewithheldeachpayperiodhere........................................................................................ 67. EXEMPT STATUS:IfyouhadarighttoarefundofALLofyourMissouriincometaxwithheldlastyearbecauseyouhadNO taxliabilityandthisyearyouexpectarefundofALLMissouriincometaxwithheldbecauseyouexpecttohave NOtaxliability, write“EXEMPT”onLine7.Seeinformationbelow............................................................................................................................... 78.IfyoumeettheconditionssetforthundertheServicememberCivilReliefAct,asamendedbytheMilitarySpousesResidency ReliefActandhavenoMissouritaxliability,write“EXEMPT”online8.Seeinformationbelow........................................................ 8

MISSOURI DEPARTMENT OF REVENUETAXATION DIVISIONP.O. BOX 3340JEFFERSON CITY, MO 65105-3340FAX: (573) 526-8079

EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE

MO W -4(REV.01-2013)

This certificate is for income tax withholdingandchildsupportenforcementpurposesonly.PLEASE TYPE OR PRINT.

FULLNAMEFILINGSTATUS

HOMEADDRESS(NUMBERANDSTREETORRURALROUTE)

SINGLEMARRIEDHEADOFHOUSEHOLD

SOCIALSECURITYNUMBER

CITYORTOWN,STATEANDZIPCODE

EMPLOYEE’SSIGNATURE(Formisnotvalidunlessyousignit.)

Underpenaltiesofperjury,IcertifythatIamentitledtothenumberofwithholdingallowancesclaimedonthiscertificate,orIamentitledtoclaimexemptstatus.DATE(MM/DD/YYYY)

NOTICE TO EMPLOYER: Within 20 days of hiring a new employee, send a copy of Form MO W-4 to the: Missouri Department of Revenue, P.O. Box 3340, Jefferson City, MO 65105-3340 or fax to (573) 526-8079. Foradditionalinformationregardingnewhirereporting,pleasevisitwww.dss.mo.gov/cse/newhire.htm.

EMPLOYER’SNAME

EMPLOYER’SADDRESS

FEDERALEMPLOYERIDENTIFICATIONNUMBER

MISSOURITAXIDENTIFICATIONNUMBER

—EmployEE InformatIon—you Do not pay mIssourI IncomE tax on all of thE IncomE you Earn!

Visit www.dor.mo.gov to try our online withholding calculator.Deductionsandexemptionsreducetheamountofyourtaxableincome.FormMOW-4iscompletedsoyoucanhaveasmuch“take-homepay”aspossiblewithoutanincometaxliabilityduetothestateofMissouriwhenyoufileyourreturn.Deductionsandexemptionsreducetheamountofyourtaxableincome.Ifyourincomeislessthanthetotalofyourpersonalexemptionplusyourstandarddeduction,youshouldmark“EXEMPT”onLine7above.ThefollowingamountsofyourannualMissouriadjustedgrossincomewillnotbetaxedbythestateofMissouriwhenyoufileyourindividualincometaxreturn.

• If your filing status ismarried filing combined and your spouseworks, do not claim anexemptiononFormMOW-4foryourspouse.

• If you and your spouse have dependents, please be sure only one of you claim thedependentsonyourFormMOW-4. Ifbothspousesclaimthedependentsasanallow-anceonFormMOW-4,itmaycauseyoutooweadditionalMissouriincometaxwhenyoufileyourreturn.

• Ifyouhavemorethanoneemployer,youshouldclaimasmallernumberornoallowanceson each FormMOW-4 filed with employers other than your principal employer so theamountwithheldwillbeclosertoyouramountoftotaltax.

• Ifyou itemizeyourdeductions, insteadofusing thestandarddeduction, theamountnottaxedbyMissourimaybeagreaterorlesseramount.

•Ifyouareclaimingan“EXEMPT”statusduetotheMilitarySpousesResidencyReliefActyou mustprovideoneofthefollowingtoyouremployer:LeaveandEarningsStatementofthenon- residentmilitaryservicemember,FormW-2issuedtothenonresidentmilitaryservicemember,a militaryidentificationcard,orspecificmilitaryordersreceivedbytheservicemember.Youmust alsoprovideverificationofresidencysuchasacopyofyourstateincometaxreturnfiledinyour stateofresidence,apropertytaxreceiptfromthestateofresidence,acurrentdriverslicense, vehicleregistrationorvoterIDcard.

$

Single$2,100 — personal exemption$6,100 — standard deduction$8,200 — Total

+ $1,200 for each dependent+ up to $5,000 for federal tax

Married Filing Combined$ 4,200 — personal exemption$12,200 — standard deduction$16,400 — Combined Total (For both spouses)

+ $1,200 for each dependent+ up to $10,000 for federal tax

Head of Household$ 3,500 — personal exemption$ 8,950 — standard deduction$12,450 — Total

+ $1,200 for each dependent+ up to $5,000 for federal tax

Items to Remember:

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MOW-4(01-2013)

TO BE COMPLETED BY EMPLOYEE

TO BE COMPLETED BY EMPLOYER

__ __ / __ __ / __ __ __ __

DATESERVICESFORPAYFIRSTPERFORMEDBYEMPLOYEE(STARTDATE) (MM/DD/YYYY)