How to complete form

2. NOTE:
IF YOU HAVE TAX QUESTIONS YOU SHOULD
SPEAK TO AN ACCOUNTANT OR A TAX
PROFESSIONAL.

4. INSTRUCTIONS

5. EMPLOYEE INFORMATION
Joe Smith 123-45-6789
123 Main Street Anywhere MS 12345

6. FILING STATUS
x 6,000

7. DEPENDENTS

8. AGE & BLINDNESS

9. TOTAL AMOUNT
6,000

10. ADDITIONAL TAXES TO WITHHOLD

11. MILITARY EXEMPTION

12. SIGNATURE
JoeSmith 7/15/2021

13. Name, Social Security Number, & Address
Filing Status
Your Signature & Date
Total Amount
Joe Smith 123-45-6789
123 Main Street Anywhere MS 12345
x 6,000
6,000
JoeSmith 7/15/2021

14. REMEMBER:
IF YOU HAVE TAX QUESTIONS YOU SHOULD
SPEAK TO AN ACCOUNTANT OR A TAX
PROFESSIONAL.