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Calculation based on: Tax Year 1999 2000 2001 2002 2003 pre 2003 post 2004 2005 2006 2007 2008 2009 pre 2009 post 2010  For  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Puerto Rico American Samoa Guam N. Mariana Islands US Virgin Islands

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General Information Gross Pay Annually Per Pay Period Gross Salary YTD   (optional) Pay Frequency Daily Weekly Bi-weekly Semi-monthly Monthly Quarterly Semi-Annually Annually Federal Filing Status Single Married Head of Household Supplemental # of Federal Allowances Additional Fed. Withholding $ I am exempt from: Federal Tax FICA Medicare State and Local Information for Arizona % of Federal 0% Exempt 10.7% 20.3% 24.5% 26.7% 33.1% 39.5% Additional State W/H $ Voluntary Deduction Section 1: Before-Tax Savings Contributions % 2: After-Tax or Roth 401(k) Savings Contributions % 3: Premium Only Plan (POP) $ 4: Other Before-Tax Deductions $ 5: FSA (Medical) $ 6: FSA (Daycare) $ 7: Total "Other" Deductions $

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