WISCONSIN STATE INCOME TAX WITHHOLDING FOR MONTHLY PENSION BENEFITS
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1 WISCONSIN STATE INCOME TAX WITHHOLDING FOR MONTHLY PENSION BENEFITS You may change your election at any time and as often as you wish. Any election to increase or decrease withholding will be effective no later than the first of the month following the date the re-election form or written notification is received as long as it is received 15 days before that date. If you elect not to have withholding apply or you do not have enough State income tax withheld from your monthly pension payments, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. The Fund cannot advise you regarding the amount to withhold for state taxes. You should discuss this with your tax advisor. / Print Full Name Social Security # / Home Address Telephone Number IF YOU WANT STATE INCOME TAX WITHHELD, COMPLETE ONE OF THE FOLLOWING AND RETURN THE FORM TO THE FUND OFFICE. YOU DO NOT NEED TO RETURN THE FORM IF YOU DO NOT WANT STATE INCOME TAX WITHHELD. 1) I want to have withholding from each monthly pension payment based on a set dollar amount. If you elect to have state income tax withheld, the amount withheld from each pension payment may not be $5.00. Set amount to be withheld $ OR 2) I want to have withholding from each monthly pension payment based on the state withholding tables. The withholding tables for married and single persons are attached. To use tables, find your monthly pension amount on the left side and your number of withholding allowances on the top. You ll find the withholding amount where these columns intersect. Marital Status: Single Married Married, but withhold at higher Single rate Number of allowances: Optional: additional amount to be withheld $ / Signature Date
2 0 340 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ SINGLE PERSONS MONTHLY PAYROLL PERIOD , ,000 1, ,020 1, ,040 1, ,060 1, ,080 1, ,100 1, ,120 1, ,140 1, ,160 1, ,180 1, ,200 1, ,220 1, ,240 1, ,260 1, ,280 1, ,300 1, ,320 1, ,340 1, ,360 1, ,380 1, ,400 1, ,420 1, ,440 1, ,460 1, ,480 1, ,500 1, ,520 1, ,540 1, ,560 1, ,580 1, ,600 1,
3 SINGLE PERSONS MONTHLY PAYROLL PERIOD (Cont d.) 1,620 1,640 $ $ $ $ $ $ $ $ $ $ $ ,640 1, ,660 1, ,680 1, ,700 1, ,720 1, ,740 1, ,760 1, ,780 1, ,800 1, ,820 1, ,840 1, ,860 1, ,880 1, ,900 1, ,920 1, ,940 1, ,960 1, ,980 2, ,000 2, ,020 2, ,040 2, ,060 2, ,080 2, ,100 2, ,120 2, ,140 2, ,160 2, ,180 2, ,200 2, ,220 2, ,240 2, ,260 2, ,280 2, ,300 2, ,320 2, ,340 2, ,360 2, ,380 2, ,400 2, ,420 2, ,440 2, ,460 2, ,480 2, ,500 2, ,520 2, ,540 2, ,560 2, ,580 2, ,600 2, ,620 2, ,640 2, ,660 2, ,680 2, ,700 2, ,720 2, ,740 2, ,760 2, ,780 2, ,800 2, ,820 2, ,840 2, ,860 2, ,880 2, ,900 2,
4 SINGLE PERSONS MONTHLY PAYROLL PERIOD (Cont d.) 2,920 2,940 $ $ $ $ $ $ $ $ $ $ $ ,940 2, ,960 2, ,980 3, ,000 3, ,020 3, ,040 3, ,060 3, ,080 3, ,100 3, ,120 3, ,140 3, ,160 3, ,180 3, ,200 3, ,220 3, ,240 3, ,260 3, ,280 3, ,300 3, ,320 3, ,340 3, ,360 3, ,380 3, ,400 3, ,420 3, ,440 3, ,460 3, ,480 3, ,500 3, ,520 3, ,540 3, ,560 3, ,580 3, ,600 3, ,620 3, ,640 3, ,660 3, ,680 3, ,700 3, ,720 3, ,740 3, ,760 3, ,780 3, ,800 3, ,820 3, ,840 3, ,860 3, ,880 3, ,900 3, ,920 3, ,940 3, ,960 3, ,980 4, ,000 4, of the excess over $4020 plus: 4,020 5, of the excess over $5245 plus: 5,245 20, of the excess over $20015 plus: and over * More than 10 exemptions: Reduce amount from 10 exemption column by $1.80 for each additional exemption claimed. 43
5 0 460 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ MARRIED PERSONS MONTHLY PAYROLL PERIOD , ,000 1, ,020 1, ,040 1, ,060 1, ,080 1, ,100 1, ,120 1, ,140 1, ,160 1, ,180 1, ,200 1, ,220 1, ,240 1, ,260 1, ,280 1, ,300 1, ,320 1, ,340 1, ,360 1, ,380 1, ,400 1, ,420 1, ,440 1, ,460 1, ,480 1, ,500 1, ,520 1, ,540 1, ,560 1, ,580 1, ,600 1, ,620 1, ,640 1, ,660 1, ,680 1, ,700 1, ,720 1,
6 MARRIED PERSONS MONTHLY PAYROLL PERIOD (Cont d.) 1,740 1,760 $ $ $ $ $ $ $ $ $ $ $ ,760 1, ,780 1, ,800 1, ,820 1, ,840 1, ,860 1, ,880 1, ,900 1, ,920 1, ,940 1, ,960 1, ,980 2, ,000 2, ,020 2, ,040 2, ,060 2, ,080 2, ,100 2, ,120 2, ,140 2, ,160 2, ,180 2, ,200 2, ,220 2, ,240 2, ,260 2, ,280 2, ,300 2, ,320 2, ,340 2, ,360 2, ,380 2, ,400 2, ,420 2, ,440 2, ,460 2, ,480 2, ,500 2, ,520 2, ,540 2, ,560 2, ,580 2, ,600 2, ,620 2, ,640 2, ,660 2, ,680 2, ,700 2, ,720 2, ,740 2, ,760 2, ,780 2, ,800 2, ,820 2, ,840 2, ,860 2, ,880 2, ,900 2, ,920 2, ,940 2, ,960 2, ,980 3, ,000 3, ,020 3,
7 MARRIED PERSONS MONTHLY PAYROLL PERIOD (Cont d.) 3,040 3,060 $ $ $ $ $ $ $ $ $ $ $ ,060 3, ,080 3, ,100 3, ,120 3, ,140 3, ,160 3, ,180 3, ,200 3, ,220 3, ,240 3, ,260 3, ,280 3, ,300 3, ,320 3, ,340 3, ,360 3, ,380 3, ,400 3, ,420 3, ,440 3, ,460 3, ,480 3, ,500 3, ,520 3, ,540 3, ,560 3, ,580 3, ,600 3, ,620 3, ,640 3, ,660 3, ,680 3, ,700 3, ,720 3, ,740 3, ,760 3, ,780 3, ,800 3, ,820 3, ,840 3, ,860 3, ,880 3, ,900 3, ,920 3, ,940 3, ,960 3, ,980 4, ,000 4, ,020 4, ,040 4, ,060 4, ,080 4, ,100 4, ,120 4, of the excess over $4140 plus: 4,140 5, of the excess over $5062 plus: 5,062 20, of the excess over $20015 plus: and over * More than 10 exemptions: Reduce amount from 10 exemption column by $1.80 for each additional exemption claimed. 46
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