W4 Personal Allowance Worksheet
Use this worksheet to set up the number of allowances you will claim on your W4.
A Check box if no one else claims you as a dependent:
B Check box if you are single and have only one job; or if you are married, have only one job, and your spouse doesn't work; or your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less:
C Check box for your spouse. But you may choose not to check if you are married and have either a working spouse or more than one job.:
D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return:
E Check box if you will file as head of household on your tax return:
F Check box if you have at least $2,000 of child or dependent care expenses for which you plan to claim credit:
G Number eligible for Child Tax Credit:
You are Single and Income Under $70,000:
You are Single and Income between $70,000 and $84,000:
You are Married and Income under $100,000:
You are Married and Income between $100,000 and $119,000:
H Total Allowances (based on your answers to A through G:
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Federal and Mississippi Payroll Withholding

.....General Information.....
For Payroll in Tax Year:
Pay Periods per Year:
(Optional: Use Pay Period )
.....Federal W4? Information.....
Federal W4 Withholding Status:
Federal W4 Allowances:
W4 Allowance Worksheet  
Federal W4 Additional Withholding Amount:
.....Mississippi Exemption Form? Information.....
State Withholding Status:
Mississippi Claimed Exemptions:
(line 6 of Withholding Certificate)
State Additional Withholding Amount:
.....Paycheck Income.....
Employee Type:     Salaried
Gross Salary per Pay Period:
Income to be taxed as supplemental income?:
.....Paycheck Deductions.....
Before Tax Retirement Benefits?:
Before Tax Cafeteria Plan Benefits?:
After Tax Deduction?:
Check for Social Security Withholding?
Check for Medicare Withholding?
Gross Salary YTD?
(Do not include this paycheck)