| Enter annual income from highest paying job: | |
| Enter annual income from 2nd highest paying job: | |
| If you have a third job enter its annual income: | |
| Enter pay periods per year of your highest paying job: | |
| Suggested extra withholding: |
| Total expected income this year: | |
| Number of Dependents Under Age 17 | |
| Number of Other Dependents | |
| Suggested Amount to put in Step 3 Line 3 of W-4 |
| Taxable Pension Income: | |
| Dividend and Interest Income: | |
| Other Income: | |
| Suggested Amount to put in Step 4 Line 4a of W-4 |
| Estimated Itemized Deductions: | |
| Expected Filing Status | |
| IRA contributions and student loan interest: | |
| Suggested Amount to put in Step 4 Line 4b of W-4 |
