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For Oregon Purposes Only

Form W-4 (2011)

Page

Deductions and Adjustments Worksheet

Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.

Enter an estimate of your 2011 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 .

{

}

$11,600 if married filing jointly or qualifying widow(er)

Enter:

$8,500 if head of household

$5,800 if single or married filing separately

Subtract line 2 from line 1. If zero or less, enter “-0-”

Enter an estimate of your 2011 adjustments to income and any additional standard deduction (see Pub. 919)

Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to

Withholding Allowances for 2011 Form W-4 Worksheet in Pub. 919.)

Enter an estimate of your 2011 nonwage income (such as dividends or interest) .

Subtract line 6 from line 5. If zero or less, enter “-0-”

Divide the amount on line 7 by $3,700 and enter the result here. Drop any fraction .

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

Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/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

Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)

Note. Use this worksheet only if the instructions under line H on page 1 direct you here.

Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)

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”

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 .

Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional

withholding amount necessary to avoid a year-end tax bill.

Enter the number from line 2 of this worksheet

Enter the number from line 1 of this worksheet

Subtract line 5 from line 4 .

Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here

Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed .

Divide line 8 by the number of pay periods remaining in 2011. For example, divide by 26 if you are paid

every two weeks and you complete this form in December 2010. Enter the result here and on Form W-4,

line 6, page 1. This is the additional amount to be withheld from each paycheck .

Table 1

Table 2

Married Filing Jointly

All Others

Married Filing Jointly

All Others

If wages from LOWEST

Enter on

If wages from LOWEST

Enter on

If wages from HIGHEST

Enter on

If wages from HIGHEST

Enter on

paying job are—

line 2 above

paying job are—

line 2 above

paying job are—

line 7 above

paying job are—

line 7 above

$0 - $5,000 -

$0 - $8,000 -

$0 - $65,000

$560

$0 - $35,000

$560

5,001 - 12,000 -

8,001 - 15,000 -

65,001 - 125,000

930

35,001 -

90,000

930

12,001 - 22,000 -

15,001 - 25,000 -

125,001 - 185,000

1,040

90,001 - 165,000

1,040

22,001 - 25,000 -

25,001 - 30,000 -

185,001 - 335,000

1,220

165,001 - 370,000

1,220

25,001 - 30,000 -

30,001 - 40,000 -

335,001 and over

1,300

370,001 and over

1,300

30,001 - 40,000 -

40,001 - 50,000 -

40,001 - 48,000 -

50,001 - 65,000 -

48,001 - 55,000 -

65,001 - 80,000 -

55,001 - 65,000 -

80,001 - 95,000 -

65,001 - 72,000 -

95,001 -120,000 -

72,001 - 85,000 -

120,001 and over

85,001 - 97,000 -

97,001 -110,000 -

110,001 -120,000 -

120,001 -135,000 -

135,001 and over

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to

You are not required to provide the information requested on a form that is

carry out the Internal Revenue laws of the United States. Internal Revenue Code sections

subject to the Paperwork Reduction Act unless the form displays a valid OMB

3402(f)(2) and 6109 and their regulations require you to provide this information; your employer

control number. Books or records relating to a form or its instructions must be

uses it to determine your federal income tax withholding. Failure to provide a properly

retained as long as their contents may become material in the administration of

completed form will result in your being treated as a single person who claims no withholding

any Internal Revenue law. Generally, tax returns and return information are

allowances; providing fraudulent information may subject you to penalties. Routine uses of this

confidential, as required by Code section 6103.

information include giving it to the Department of Justice for civil and criminal litigation, to

The average time and expenses required to complete and file this form will vary

cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in

depending on individual circumstances. For estimated averages, see the

administering their tax laws; and to the Department of Health and Human Services for use in

instructions for your income tax return.

the National Directory of New Hires. We may also disclose this information to other countries

If you have suggestions for making this form simpler, we would be happy to hear

under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to

from you. See the instructions for your income tax return.

federal law enforcement and intelligence agencies to combat terrorism.

Form W-4 - Employee'S Withholding Allowance Certificate - For Oregon Purposes Only - 2011 Page 2

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