Calculation based on: Tax Year  For 
Instructions: Click an item's name for help on contents.
General Information

Gross Pay

Gross Salary YTD

  (optional)

Pay Frequency

Federal Filing Status

# of Federal Allowances

Additional Fed. Withholding

$

Round Federal Withholding

Yes No

I am exempt from:

Federal Tax FICA Medicare
State and Local Information for Arizona

% of Federal

Additional State W/H

$
Voluntary Deduction Section
Use voluntary deduction(s) for my paycheck.

Deduction #1 Name

Deduction #1 Amount

Ded. #1 Exempt from:

Federal FICA State Local

Deduction #2 Name

Deduction #2 Amount

Ded. #2 Exempt from:

Federal FICA State Local
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