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Zip Single Married/Civil Union Couple Joint Married/Civil Union Couple Separate Head of Household 5. Name Qualifying Widow(er)/Surviving Civil Union Partner 3. If you have chosen to use the chart from instruction A, enter the appropriate letter here . . . . . . . . . . . 3. 4. Total number of allowances you are claiming (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Additional amount you want deducted from each pay . . . . . . . . . . . . . . . . . .

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