Summary: This is an example of Form W-4 (2012), page 2 with items included as described in the
text.

- These items are completed in the Deductions and Adjustments Worksheet.
1. Enter an estimate of your 2012 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and miscellaneous deductions.

field contains 12,800 2. Enter $11,900 if married filing jointly or qualifying widow or widower, $8,700 if head of household, $5,950 if single or married filing separately

field contains 11,9003. Subtract line 2 from line 1. If zero or less, enter 0

field contains 9004. Enter an estimate of your 2012 adjustments to income and any additional standard deduction. (Pub 505)

field contains 4,0005. Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2012 Form W-4 Worksheet in Pub. 505.)

field contains 4,9006. Enter an estimate of your 2012 nonwage income (such as dividends or interest)

field contains 6007. Subtract line 6 from line 5. If zero or less, enter 0

field contains 4,3008. Divide the amount on line 7 by 3,800 and enter the result here. Drop any fraction

field contains 19. Enter the number from the Personal Allowances Worksheet, line H, page 1

field contains 910. Add lines 8 and 9 and enter the total here. If you plan to use the Two Earner/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1

field contains 10

- These items are completed in the Two Earners/Multiple Jobs Worksheet.
1. Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)

field contains 10 2. Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than 3

field contains 23. If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter 0) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet

field contains 8