Employee form
Ava Bennett
CompleteW-4 withholding
W-4 withholding
This intake record does not replace the official W-4 or I-9. Complete the original in your employer's designated system; your manager must verify it before this task can finish.
- Filing status (Step 1c)
- Single or married filing separately
- Two jobs, or a working spouse (Step 2c checked)
- No
- Dependents amount (Step 3)
- 0.00
- Other income (Step 4a)
- 0.00
- Deductions (Step 4b)
- 0.00
- Extra withholding per paycheck (Step 4c)
- 50.00
- Claims exemption from withholding
- No
- State form: filing status
- Not given
- State form: allowances or exemptions
- —
- State form: extra withholding per paycheck
- —
- Arizona A-4: percent elected
- —
- Last four of your SSN
- 2916
- Signed on
- 2024-12-05
Manager verification
- Original form record reference
- Gusto > People > Ava Bennett > Documents: Form W-4 signed 12/05/2024
- I verified the completed official form in our designated records system
- Yes
Submission history
- Sept. 22, 2026, 11:05 a.m. · dana.whitfield@frontrange-roofing.example Sept. 22, 2026, 11:05 a.m. · dana.whitfield@frontrange-roofing.example · Approved Download submitted copy