North Dakota Form NDW-R - Symmetry Payroll Forms

North Dakota Form NDW-R
Reciprocity exemption from withholding for qualifying Minnesota and
Montana residents working in North Dakota
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© Copyright 2003-2008, Symmetry Software, all rights reserved
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Form
North Dakota Office of State Tax Commissioner
NDW-R
Reciprocity exemption from withholding for qualifying Minnesota and
Montana residents working in North Dakota
Please type or print in black or blue ink. Fill in circles completely.
Print Form
See instructions on back before completing
For calendar year:
20
08
Employee information
Employee's name (last, first, mdidle initial)
Employee's social security number
Employee's permanent address
State (fill in
applicable circle)
Minnesota
Montana
City
Zip code
Employee residency information
1. I
have lived at the above address since (month/day/year):
Month/Day/Year
2. Will you return to the above address at least once a month?
3. Were you ever a resident of North Dakota in the past three years?
Yes
No
Yes
If you are a resident of Minnesota and answer "No" to this
question, you do not qualify for this exemption.
No
If yes, fill in the dates you were a North
Dakota resident (month/day/year):
to
Month/Day/Year
Month/Day/Year
4. Fill in the wages you earned in North Dakota during the previous calendar year:
Employer information
Current employer's name
Employer's federal ID
Employer's mailing address
Phone number
City
State
Zip code
Employee's signature
I declare under the penalties of North Dakota Century Code §12.1-11-02, which provides for a Class A misdemeanor for making a false statement in a
governmental matter, that this form has been examined by me and to the best of my knowledge and belief is true, correct, and complete.
10/31/2008
Employee's signature
Date signed
Employee's daytime phone number
Employee - Make a copy for your records. Give this completed form to your employer.
Employer - Verify that the Employer's Federal ID is correct. Make a copy for your records.
Mail this form to: Office of State Tax Commissioner, 600 E Boulevard Ave., Dept. 127, Bismarck, ND 58505-0599.
www.ndtaxdepartment.gov
Form NDW-R instructions
Instructions for
employee
North Dakota has income tax reciprocity
agreements with Minnesota and Montana.
If you are a resident of one of these
states, the agreements provide that
you do not have to pay North Dakota
income tax on wages you earn for work
in North Dakota. If you are a resident
of Minnesota, this applies only if you
return to your permanent residence in
Minnesota at least once a month.
Note: The wages you earn for work in
North Dakota are subject to income tax
in your state of residence.
If you do not want North Dakota
income tax withheld from your wages,
you must complete this form and give
it to your employer by February 28 of
the calendar year for which you want
it to apply, or within 30 days after you
begin working or change your permanent
residence. You must complete a new
form and give it to your employer each
year to continue the exemption from
withholding.
If you do not complete this form and give
it to your employer as explained above,
your employer must withhold North
Dakota income tax from your wages.
If North Dakota income tax was
already withheld from your wages, you
must complete and file a North Dakota
income tax return at the end of the year to
obtain a refund.
Fill out the form completely
If you do not fill in every item on this
form, your employer must withhold
North Dakota income tax from your
wages. Sign and date the form. Your
phone number is not required, but we ask
for it so we can contact you if we have
questions.
Your employer will be able to provide
you with the correct federal ID number if
you do not have this information.
Make a copy of this form for your records
and give the original to your employer.
Use of information
All information on this form is
confidential by state law. It may only
be given to your state of residence, the
Internal Revenue Service, other states
that guarantee the same confidentiality,
and to other state agencies as provided by
law. The information may be compared
with other information you furnished to
the Office of State Tax Commissioner.
Your name, address and social security
number are required for identification.
Your address is also required to verify
your state of residence. Your employer’s
name, address, federal ID number and
phone number are required in case we
have to contact your employer regarding
withholding income tax from your
wages. If you do not complete any of this
information, your employer is required to
withhold North Dakota income tax from
your wages.
Instructions for
employer
Employees who reside in Minnesota or
Montana who ask you not to withhold
North Dakota income tax from their
wages must complete this form and give
it to you by February 28 or within 30
days after they begin working for you
or change their residence. Employees
who live in other states, including North
Dakota, cannot use this form.
For forms received by February 28, mail
the original on or before March 31 to:
Office of State Tax Commissioner
600 E. Boulevard Ave., Dept. 127
Bismarck, ND 58505-0599
For new employees or employees who
change their permanent home address,
mail the original to the above address
within 30 days of receipt.
Please verify your federal ID number is
correct. Make a copy of the completed
form for your records.
If an employee does not fill in every item
on this form and the employee does not
correct the omission, you must withhold
North Dakota income tax from the
employee’s wages.
An employee must complete this form
and give it to you each year to continue
the exemption from withholding.
Need forms or assistance?
Visit our web site
You can download tax forms, ask us a question or send us a message via e-mail, and find other useful information on our web site
at: www.ndtaxdepartment.gov.
Call us
Call us at (701) 328-3125. If speech or hearing impaired, call us through Relay North Dakota at 1-800-366-6888.
Write to us
You may also write to: Office of State Tax Commissioner, 600 E. Boulevard Ave., Dept. 127, Bismarck, ND 58505-0599.