Pay Periods Per Year  

Federal W4 Withholding Status   Single Married

Federal W4 Allowances  

State Withholding Status   SingleMarriedHead of HouseholdMarried Both Working

Mississippi Claimed Exemptions:
(line 6 of Withholding Certificate)  

Gross Salary Per Pay Period  

401(k), 403(b), etc Amount  

Before Tax Cafeteria Plan Amount