Pay Periods Per Year  

Federal W4 Withholding Status   Single Married

Federal W4 Allowances  

Indiana Withholding Status   Single Married

Indiana Claimed Dependents

Indiana Claimed Allowances

County: None Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur Dekalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko Lagrange Laporte Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Pulaski Putnam Randolph Ripley Rush St Joseph Scott Shelby Spencer Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley Resident Non-resident

Gross Salary Per Pay Period  

401(k), 403(b), etc Amount  

Before Tax Cafeteria Plan Amount