| Your income |
Your total gross income from
your paycheck |
| Other income |
Any other income that you receive
including bonuses, alimony, child support or income from a
business |
| Federal tax withholding |
Total amount withheld for federal
taxes. Enter this amount from your paystub. |
| State tax withholding |
Total amount withheld for state
taxes. Enter this amount from your paystub. |
| Local tax withholding |
Total amount withheld for local
taxes. Enter this amount from your paystub. |
| Other taxes and withholdings |
Total amount withheld for any
other taxes or miscellaneous item. Enter this amount from
your paystub. |
| FICA |
Total withheld for FICA based
on the gross income on you paycheck |
| Medicare |
Total withheld for Medicare
based on the gross income on you paycheck |
| Insurance and benefits |
Total amount withheld for insurance
and benefits by your employer. Enter this amount from you
paystub. |
| Company savings plan |
Total amount withheld from your
paycheck that is deposited into a company savings plan such
as a 401(k) or 403(b) |
