MS – Horizons Portal

Download W4 Instructions
Marital Status
1. "Single" – Enter $6,000 as exemption
2a. "Married" Spouse Not Employed Enter $12,000
2b. Spouse IS employed: Enter that part of $12,000 claimed by you in multiples of $500. See instructions 2(b) below

Head of Family
3. Enter $9,500 as exemption. To qualify as head of family, you must be single and have a dependent living in the home with you. See instructions 2(c) and 2(d)below
Dependents

4. You may claim $1,500 for each dependent@, other than for taxpayer and spouse, who receives chief support from you and who qualifies as a dependent for Federal income tax purposes.
* A head of family may claim $1,500 for each dependents excluding the one which qualifies you as head of family. Multiply number of dependents claimed by you by $1,500.
Enter amount claimed
Age and Blindness
5a. Age 65 or Older
- Husband
- Wife
- Single
5b. Blind
- Husband
- Wife
- Single
6. Total amount of Exemptions Claimed
7. Additional dollar amount of withholding per pay period if agreed to by your employer
8. If you meet the conditions set forth under the Service Member Civil Relief, as amended by the Military Spouses Residency Relief Act, and have no Mississippi tax liability, write "EXEMPT" on Line 8. You must attach a copy of the Federal Form DD-2058 and a copy of your Military Spouse ID Card to this form so your employer can validate the exemption claim

Under penalties of perjury, I certify that I have examined this certificate and to the best of my knowledge and belief, it is true, correct, and complete.*
- I certify the above statement
Social Security Number*
Employee Signature – Type Your Name*
Today's Date*
My IP Address is: 44.192.115.114
This form was submitted on: 09/21/2023

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