Schedule In-H - State Form 48684 - Indiana Household Employment Taxes - 2012 Page 2
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1
2Part II: State and County Tax Withholding
Line 4 - Enter the 2-digit county code from Indiana Departmen-
tal Notice #1 for which the line 3 county tax was withheld.
Enter below the employee's name and Social Security number
as it appears on his/her W-2 form. Attach additional pages if
Summary -
withholding for more than three household employees.
♦
Add all line 2 amounts and enter on Part I, line 1.
♦
Add all line 3 amounts and enter on Part I, line 2.
Line 1 - Enter the amount on which you are withholding federal
income tax (also enter on W-2 boxes 16 and 18.)
Note: Get Form WH-4 and Departmental Notice #1 for detailed
information on how to calculate state and county withholding
Line 2 - Enter the amount of Indiana state tax withheld (also
amounts and to get the county code numbers. This informa-
enter on W-2 box 17. Also, enter "IN" on W-2 box 15.)
tion is available on our web site at
and
Line 3 - Enter the amount of county tax withheld (also enter
on W-2 box 19.)
Employee Name (First, M.I., Last)
Employee Social Security Number
.00
Income __________________________________________________________________________
1
.00
State Tax Withheld ________________________________________________________________
2
.00
County Tax Withheld ______________________________________________________________
3
County Code Number (2-digit) _________________________________________________________ 4
Employee Name (First, M.I., Last)
Employee Social Security Number
.00
Income __________________________________________________________________________
1
.00
State Tax Withheld ________________________________________________________________
2
.00
County Tax Withheld ______________________________________________________________
3
County Code Number (2-digit) _________________________________________________________ 4
Employee Name (First, M.I., Last)
Employee Social Security Number
.00
Income __________________________________________________________________________
1
.00
State Tax Withheld ________________________________________________________________
2
.00
County Tax Withheld ______________________________________________________________
3
County Code Number (2-digit) _________________________________________________________ 4
*24100000000*
24100000000
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