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Auto Calculation
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State
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Alaska
Arizona
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California
Colorado
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Delaware
District Of Columbia
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Hawaii
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Texas
Utah
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Washington
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Washington DC
Martial Status
Single
Married
Head of house hold
Last Annual Income Without Tax
a Employee's social security number
b Employer identification number (EIN)
c Employer's name, address, and ZIP code
d Control number
e Employee first name
Employee last name
f Employee's address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8 Allocated tips
10 Dependent care benefits
11 Nonqualified plans
12a See instructions for box 12
12b
12c
12d
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
14b Other
15 State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer's state ID number
16 State wages, tips, etc.
17 State income tax
18 Local wages, tips, etc.
19 Local income tax
20 Locality name
Order Detail
Description
Amount
Item Price
$6.99
Total
$6.99 USD
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