Arizona Form 2021 A-4 Employee’s Arizona Withholding

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Arizona FormA-42021Employee’s Arizona Withholding ElectionType or print your Full NameYour Social Security NumberHome Address – number and street or rural routeCity or TownStateZIP CodeChoose either box 1 or box 2: 1 Withhold from gross taxable wages at the percentage checked (check only one percentage): 0.8% 1.3% 1.8% 2.7% 3.6% 4.2% Check this box and enter an extra amount to be withheld from each paycheck. 5.1% 2 I elect an Arizona withholding percentage of zero, and I certify that I expect to haveno Arizona tax liability for the current taxable year.PrintI certify that I have made the election marked above. SIGNATUREDATEEmployee’s InstructionsArizona law requires your employer to withhold Arizona incometax from your wages for work done in Arizona. The amountwithheld is applied to your Arizona income tax due when youfile your tax return. The amount withheld is a percentage ofyour gross taxable wages from every paycheck. You mayalso have your employer withhold an extra amount from eachpaycheck. Complete this form to select a percentage and anyextra amount to be withheld from each paycheck.What are my “Gross Taxable Wages”?For withholding purposes, your “gross taxable wages” are thewages that will generally be in box 1 of your federal Form W-2.It is your gross wages less any pretax deductions, such as yourshare of health insurance premiums.New EmployeesComplete this form within the first five days of your employmentto select an Arizona withholding percentage. You may alsohave your employer withhold an extra amount from eachpaycheck. If you do not give this form to your employer thedepartment requires your employer to withhold 2.7% of yourgross taxable wages.Current EmployeesIf you want to change your current amount withheld, you mustfile this form to change the Arizona withholding percentage orto change the extra amount withheld.What Should I do With Form A-4?Give your completed Form A-4 to your employer.ADOR 10121 (20)Electing a Withholding Percentage of ZeroYou may elect an Arizona withholding percentage of zeroif you expect to have no Arizona income tax liability for thecurrent year. Arizona tax liability is gross tax liability less anytax credits, such as the family tax credit, school tax credits, orcredits for taxes paid to other states. If you make this election,your employer will not withhold Arizona income tax from yourwages for payroll periods beginning after the date you file theform. To keep this election for the next calendar year, you mustgive your employer an updated Form A-4. If you do not, youremployer may withhold Arizona income tax from your wagesand salary until you submit an updated Form A-4.Zero withholding does not relieve you from paying Arizonaincome taxes that might be due at the time you file your Arizonaincome tax return. If you have an Arizona tax liability whenyou file your return or if at any time during the current yearconditions change so that you expect to have a tax liability, youshould promptly file a new Form A-4 and choose a withholdingpercentage that applies to you.Voluntary Withholding Election by CertainNonresident EmployeesCompensation earned by nonresidents while physicallyworking in Arizona for temporary periods is subject to Arizonaincome tax. However, under Arizona law, compensation paidto certain nonresident employees is not subject to Arizonaincome tax withholding. These nonresident employees needto review their situations and determine if they should elect tohave Arizona income taxes withheld from their Arizona sourcecompensation. Nonresident employees may request that theiremployer withhold Arizona income taxes by completing thisform to elect Arizona income tax withholding.

Intuit QuickBooks Payroll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Employee Direct Deposit AuthorizationInstructionsEmployee: Fill out and return to your employer.Employer: Save for your files only.This document must be signed by employees requesting automatic deposit of paychecks andretained on file by the employer. Do not send this form to Intuit. Employees must attach a voidedcheck for each of their accounts to help verify their account numbers and bank routing numbers.Account 1Account 1 type:CheckingSavingsBank routing number (ABA number):Account number:Percentage or dollar amount to be deposited to this account:Account 2 (remainder to be deposited to this account)Account 2 type:CheckingSavingsBank routing number (ABA number):Account number:attach a voided check for each account hereAuthorization (enter your company name in the blank space below)This authorizes(the “Company”)to send credit entries (and appropriate debit and adjustment entries), electronically or by any othercommercially accepted method, to my (our) account(s) indicated below and to other accounts I (we) identify inthe future (the “Account”). This authorizes the financial institution holding the Account to post all such entries. Iagree that the ACH transactions authorized herein shall comply with all applicable U.S. Law. This authorizationwill be in effect until the Company receives a written termination notice from myself and has a reasonableopportunity to act on it.Authorized signature:Employee ID #:Print name:Date:Employee Direct Deposit Authorization FormVer. Authorization for Direct Deposit-061812

Arizona National Livestock Show, Inc.Applicant InformationFull Name:Date:LastFirstM.I.Address:Street AddressApartment/Unit #CityStatePhone:ZIP CodeEmailPosition Applied for:Available Start Date:Are you a citizen of the United States?Have you ever worked for this company?Have you ever been convicted of a felony?YESNOYESNOYESNOIf no, are you authorized to work in the U.S.?YESNOIf yes, when?If yes, explain:EducationHigh School:From:Address:To:Did you o:Did you graduate?Degree:Previous EmploymentCompany:Phone:Address:Supervisor:Job Title:Starting Salary: Ending Salary: Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YESNODisclaimer and SignatureI certify that my answers are true and complete to the best of my knowledge. If this application leads toemployment, I understand that false or misleading information in my application or interview may result in myrelease.I understand employment at Arizona National Livestock Show, Inc. is “at will” and either I or Arizona NationalLivestock Show, Inc. can terminate the employment relationship at any time, with or without prior notice, and forany reason not prohibited by statue.Signature:Date:

Arizona National Livestock Show, Inc.Employee InformationFull Name:Date of Birth:LastFirstM.I.Address:Street AddressApartment/Unit #CityStatePhone:ZIP CodeEmail:Insurance Carrier:Policy #:Hospital Preference:Physician:Please list any allergies:Emergency Contact #1 InformationFull Name:Relationship:LastFirstM.I.Address:Street AddressApartment/Unit #CityStatePhone #1:ZIP CodePhone #2Emergency Contact #2 InformationFull Name:Relationship:LastFirstM.I.Address:Street AddressApartment/Unit #CityPhone #1:StateZIP CodePhone #2Disclaimer and SignatureI have voluntarily provided the above information and authorize Arizona National Livestock Show, Inc. and itsrepresentatives to contact any of the above on my behalf in the event of an emergency.Signature:Date:

USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 10/31/2022 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,during completion of this form. Employers are liable for errors in the completion of this form.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) anemployee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because thedocumentation presented has a future expiration date may also constitute illegal discrimination.Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no laterthan the first day of employment, but not before accepting a job offer.)Last Name (Family Name)Address (Street Number and Name)Date of Birth (mm/dd/yyyy)Middle InitialFirst Name (Given Name)Apt. NumberU.S. Social Security Number-Other Last Names Used (if any)StateCity or TownZIP CodeEmployee's Telephone NumberEmployee's E-mail Address-I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents inconnection with the completion of this form.I attest, under penalty of perjury, that I am (check one of the following boxes):1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident(Alien Registration Number/USCIS Number):4. An alien authorized to workuntil (expiration date, if applicable, mm/dd/yyyy):Some aliens may write "N/A" in the expiration date field. (See instructions)QR Code - Section 1Do Not Write In This SpaceAliens authorized to work must provide only one of the following document numbers to complete Form I-9:An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.1. Alien Registration Number/USCIS Number:OR2. Form I-94 Admission Number:OR3. Foreign Passport Number:Country of Issuance:Signature of EmployeeToday's Date (mm/dd/yyyy)Preparer and/or Translator Certification (check one):I did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1.(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct.Today's Date (mm/dd/yyyy)Signature of Preparer or TranslatorLast Name (Family Name)Address (Street Number and Name)First Name (Given Name)City or TownStateZIP CodeEmployer Completes Next PageForm I-9 10/21/2019Page 1 of 3

USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 10/31/2022Section 2. Employer or Authorized Representative Review and Verification(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. Youmust physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Listsof Acceptable Documents.")Employee Info from Section 1Last Name (Family Name)List AM.I.First Name (Given Name)ORList BCitizenship/Immigration StatusANDList CIdentityIdentity and Employment AuthorizationEmployment AuthorizationDocument TitleDocument TitleDocument TitleIssuing AuthorityIssuing AuthorityIssuing AuthorityDocument NumberDocument NumberDocument NumberExpiration Date (if any) (mm/dd/yyyy)Expiration Date (if any) (mm/dd/yyyy)Expiration Date (if any) (mm/dd/yyyy)Document TitleQR Code - Sections 2 & 3Do Not Write In This SpaceAdditional InformationIssuing AuthorityDocument NumberExpiration Date (if any) (mm/dd/yyyy)Document TitleIssuing AuthorityDocument NumberExpiration Date (if any) (mm/dd/yyyy)Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge theemployee is authorized to work in the United States.The employee's first day of employment (mm/dd/yyyy):Signature of Employer or Authorized RepresentativeLast Name of Employer or Authorized Representative(See instructions for exemptions)Today's Date (mm/dd/yyyy)Title of Employer or Authorized RepresentativeFirst Name of Employer or Authorized RepresentativeEmployer's Business or Organization Address (Street Number and Name)City or TownEmployer's Business or Organization NameStateZIP CodeSection 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)A. New Name (if applicable)Last Name (Family Name)B. Date of Rehire (if applicable)First Name (Given Name)Middle InitialDate (mm/dd/yyyy)C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishescontinuing employment authorization in the space provided below.Document TitleDocument NumberExpiration Date (if any) (mm/dd/yyyy)I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and ifthe employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.Signature of Employer or Authorized RepresentativeForm I-9 10/21/2019Today's Date (mm/dd/yyyy)Name of Employer or Authorized RepresentativePage 2 of 3

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIREDEmployees may present one selection from List Aor a combination of one selection from List B and one selection from List C.LIST ADocuments that EstablishBoth Identity andEmployment Authorization1. U.S. Passport or U.S. Passport Card2. Permanent Resident Card or AlienRegistration Receipt Card (Form I-551)3. Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machinereadable immigrant visa4. Employment Authorization Documentthat contains a photograph (FormI-766)5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:a. Foreign passport; andb. Form I-94 or Form I-94A that hasthe following:(1) The same name as the passport;and(2) An endorsement of the alien'snonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.6. Passport from the Federated Statesof Micronesia (FSM) or the Republicof the Marshall Islands (RMI) withForm I-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMILIST BLIST CDocuments that EstablishEmployment AuthorizationDocuments that EstablishIdentityORAND1. Driver's license or ID card issued by aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address2. ID card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and address3. School ID card with a photograph4. Voter's registration card5. U.S. Military card or draft record6. Military dependent's ID card7. U.S. Coast Guard Merchant MarinerCard8. Native American tribal document9. Driver's license issued by a Canadiangovernment authorityFor persons under age 18 who areunable to present a documentlisted above:1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:(1) NOT VALID FOR EMPLOYMENT(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal4. Native American tribal document5. U.S. Citizen ID Card (Form I-197)6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)7. Employment authorizationdocument issued by theDepartment of Homeland Security10. School record or report card11. Clinic, doctor, or hospital record12. Day-care or nursery school recordExamples of many of these documents appear in the Handbook for Employers (M-274).Refer to the instructions for more information about acceptable receipts.Form I-9 10/21/2019Page 3 of 3

W-4Employee’s Withholding CertificateForm(Rev. December 2020)aDepartment of the TreasuryInternal Revenue ServiceStep 1:EnterPersonalInformationOMB No. 1545-0074Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.a Give Form W-4 to your employer.a Your withholding is subject to review by the IRS.(a) First name and middle initialLast name(b) Social security numberAddressa Does your name match thename on your social securitycard? If not, to ensure you getcredit for your earnings, contactSSA at 800-772-1213 or go towww.ssa.gov.City or town, state, and ZIP code(c)2021Single or Married filing separatelyMarried filing jointly or Qualifying widow(er)Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who canclaim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy.Step 2:Multiple Jobsor SpouseWorksComplete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spousealso works. The correct amount of withholding depends on income earned from all of these jobs.Do only one of the following.(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This optionis accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . . aTIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employmentincome, including as an independent contractor, use the estimator.Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding willbe most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)Step 3:ClaimDependentsIf your total income will be 200,000 or less ( 400,000 or less if married filing jointly):Multiply the number of qualifying children under age 17 by 2,000 a Multiply the number of other dependents by 500Add the amounts above and enter the total hereStep 4(optional):OtherAdjustments.a .3 (a) Other income (not from jobs). If you want tax withheld for other income you expectthis year that won’t have withholding, enter the amount of other income here. This mayinclude interest, dividends, and retirement income . . . . . . . . . . . .4(a) (b) Deductions. If you expect to claim deductions other than the standard deductionand want to reduce your withholding, use the Deductions Worksheet on page 3 andenter the result here . . . . . . . . . . . . . . . . . . . . .4(b) (c) Extra withholding. Enter any additional tax you want withheld each pay period4(c) FEmployersOnly.Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.FStep 5:SignHere.Employee’s signature (This form is not valid unless you sign it.)Employer’s name and addressFor Privacy Act and Paperwork Reduction Act Notice, see page 3.First date ofemploymentCat. No. 10220QDateEmployer identificationnumber (EIN)Form W-4 (2021)

Page 2Form W-4 (2021)General InstructionsSpecific InstructionsFuture DevelopmentsStep 1(c). Check your anticipated filing status. This willdetermine the standard deduction and tax rates used tocompute your withholding.Step 2. Use this step if you (1) have more than one job at thesame time, or (2) are married filing jointly and you and yourspouse both work.Option (a) most accurately calculates the additional taxyou need to have withheld, while option (b) does so with alittle less accuracy.If you (and your spouse) have a total of only two jobs, youmay instead check the box in option (c). The box must alsobe checked on the Form W-4 for the other job. If the box ischecked, the standard deduction and tax brackets will becut in half for each job to calculate withholding. This optionis roughly accurate for jobs with similar pay; otherwise, moretax than necessary may be withheld, and this extra amountwill be larger the greater the difference in pay is between thetwo jobs.Multiple jobs. Complete Steps 3 through 4(b) on only! one Form W-4. Withholding will be most accurate ifCAUTIONyou do this on the Form W-4 for the highest paying job.Step 3. This step provides instructions for determining theamount of the child tax credit and the credit for otherdependents that you may be able to claim when you file yourtax return. To qualify for the child tax credit, the child mustbe under age 17 as of December 31, must be yourdependent who generally lives with you for more than halfthe year, and must have the required social security number.You may be able to claim a credit for other dependents forwhom a child tax credit can’t be claimed, such as an olderchild or a qualifying relative. For additional eligibilityrequirements for these credits, see Pub. 972, Child TaxCredit and Credit for Other Dependents. You can alsoinclude other tax credits in this step, such as education taxcredits and the foreign tax credit. To do so, add an estimateof the amount for the year to your credits for dependentsand enter the total amount in Step 3. Including these creditswill increase your paycheck and reduce the amount of anyrefund you may receive when you file your tax return.Step 4 (optional).Step 4(a). Enter in this step the total of your otherestimated income for the year, if any. You shouldn’t includeincome from any jobs or self-employment. If you completeStep 4(a), you likely won’t have to make estimated taxpayments for that income. If you prefer to pay estimated taxrather than having tax on other income withheld from yourpaycheck, see Form 1040-ES, Estimated Tax for Individuals.Step 4(b). Enter in this step the amount from the DeductionsWorksheet, line 5, if you expect to claim deductions other thanthe basic standard deduction on your 2021 tax return andwant to reduce your withholding to account for thesedeductions. This includes both itemized deductions and otherdeductions such as for student loan interest and IRAs.Step 4(c). Enter in this step any additional tax you wantwithheld from your pay each pay period, including anyamounts from the Multiple Jobs Worksheet, line 4. Entering anamount here will reduce your paycheck and will either increaseyour refund or reduce any amount of tax that you owe.For the latest information about developments related toForm W-4, such as legislation enacted after it was published,go to www.irs.gov/FormW4.Purpose of FormComplete Form W-4 so that your employer can withhold thecorrect federal income tax from your pay. If too little iswithheld, you will generally owe tax when you file your taxreturn and may owe a penalty. If too much is withheld, youwill generally be due a refund. Complete a new Form W-4when changes to your personal or financial situation wouldchange the entries on the form. For more information onwithholding and when you must furnish a new Form W-4,see Pub. 505, Tax Withholding and Estimated Tax.Exemption from withholding. You may claim exemptionfrom withholding for 2021 if you meet both of the followingconditions: you had no federal income tax liability in 2020and you expect to have no federal income tax liability in2021. You had no federal income tax liability in 2020 if (1)your total tax on line 24 on your 2020 Form 1040 or 1040-SRis zero (or less than the sum of lines 27, 28, 29, and 30), or(2) you were not required to file a return because yourincome was below the filing threshold for your correct filingstatus. If you claim exemption, you will have no income taxwithheld from your paycheck and may owe taxes andpenalties when you file your 2021 tax return. To claimexemption from withholding, certify that you meet both ofthe conditions above by writing “Exempt” on Form W-4 inthe space below Step 4(c). Then, complete Steps 1(a), 1(b),and 5. Do not complete any other steps. You will need tosubmit a new Form W-4 by February 15, 2022.Your privacy. If you prefer to limit information provided inSteps 2 through 4, use the online estimator, which will alsoincrease accuracy.As an alternative to the estimator: if you have concernswith Step 2(c), you may choose Step 2(b); if you haveconcerns with Step 4(a), you may enter an additional amountyou want withheld per pay period in Step 4(c). If this is theonly job in your household, you may instead check the boxin Step 2(c), which will increase your withholding andsignificantly reduce your paycheck (often by thousands ofdollars over the year).When to use the estimator. Consider using the estimator atwww.irs.gov/W4App if you:1. Expect to work only part of the year;2. Have dividend or capital gain income, or are subject toadditional taxes, such as Additional Medicare Tax;3. Have self-employment income (see below); or4. Prefer the most accurate withholding for multiple jobsituations.Self-employment. Generally, you will owe both income andself-employment taxes on any self-employment income youreceive separate from the wages you receive as anemployee. If you want to pay these taxes throughwithholding from your wages, use the estimator atwww.irs.gov/W4App to figure the amount to have withheld.Nonresident alien. If you’re a nonresident alien, see Notice1392, Supplemental Form W-4 Instructions for NonresidentAliens, before completing this form.F

Page 3Form W-4 (2021)Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONEForm W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.Note: If more than one job has annual wages of more than 120,000 or there are more than three jobs, see Pub. 505 for additionaltables; or, you can use the online withholding estimator at www.irs.gov/W4App.12Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have onejob, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the“Lower Paying Job” column, find the value at the intersection of the two household salaries and enterthat value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . .4 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and2c below. Otherwise, skip to line 3.a31Find the amount from the appropriate table on page 4 using the annual wages from the highestpaying job in the “Higher Paying Job” row and the annual wages for your next highest paying jobin the “Lower Paying Job” column. Find the value at the intersection of the two household salariesand enter that value on line 2a . . . . . . . . . . . . . . . . . . . . . . .2a b Add the annual wages of the two highest paying jobs from line 2a together and use the total as thewages in the “Higher Paying Job” row and use the annual wages for your third job in the “LowerPaying Job” column to find the amount from the appropriate table on page 4 and enter this amounton line 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . .2b c2c Add the amounts from lines 2a and 2b and enter the result on line 2c .Enter the number of pay periods per year for the highest paying job. For example, if that job paysweekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . .3Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter thisamount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additionalamount you want withheld) . . . . . . . . . . . . . . . . . . . . . . . . .4 1 2 Step 4(b)—Deductions Worksheet (Keep for your records.)1Enter an estimate of your 2021 itemized deductions (from Schedule A (Form 1040)). Such deductionsmay include qualifying home mortgage interest, charitable contributions, state and local taxes (up to 10,000), and medical expenses in excess of 7.5% of your income . . . . . . . . . . . .{} 25,100 if you’re married filing jointly or qualifying widow(er) 18,800 if you’re head of household 12,550 if you’re single or married filing separately2Enter:3If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greaterthan line 1, enter “-0-”. . . . . . . . . . . . . . . . . . . . . . . . . .3 Enter an estimate of your student loan interest, deductible IRA contributions, and certain otheradjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information. . . .4 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 .5 45Privacy Act and Paperwork Reduction Act Notice. We ask for the informationon this form to carry out the Internal Revenue laws of the United States. InternalRevenue Code sections 3402(f)(2) and 6109 and their regulations require you toprovide this information; your employer uses it to determine your federal incometax withholding. Failure to provide a properly completed form will result in yourbeing treated as a single person with no other entries on the form; providingfraudulent information may subject you to penalties. Routine uses of thisinformation include giving it to the Department of Justice for civil and criminallitigation;

This authorization will be in effect until the Company receives a written termination notice from myself and has a reasonable opportunity to act on it. Authorized signature: Employee ID #: Print name: Date: Employee Direct Deposit Authorization Form Ver. Authorization_for_Direct_Deposit-061812 Employee Direct Deposit Authorization

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