EMPLOYEE'S WITHHOLDING INFORMATION SHEET by tbe46559

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									EMPLOYEE’S WITHHOLDING INFORMATION SHEET


For STATE withholding,              My filing Status is:     SINGLE
                                                             MARRIED
                                                             DUAL

                                    My # of Exemptions:


For FEDERAL withholding,            My filing Status is:     SINGLE
                                                             MARRIED
                                                             DUAL

                                    My # of Exemptions:

Per my request, please withhold $          additional STATE TAX
from my paycheck.


Per my request, please withhold $         additional FEDERAL TAX
from my paycheck.


PLEASE STOP ANY ADDITIONAL TAX DEDUCTION FROM MY PAYCHECK


              STATE TAX                          FEDERAL TAX



EMPLOYEE SIGNATURE

EMPLOYEE S.S.#                            DATE

								
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