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The amount is to be determined by using the applicable withholding tables or approved withholding formlua Total Number of Allowance You Are Claiming Additional Amount You Want Deducted From Each Pay Signature of Employee PS Form 1198 March 1987 Date of Request Effective Date Privacy Act Statement The collection of this information is authorized by 39 USC 401 1003 5 USC 8339. U*S* Postal Service Request for State Income Tax Withholding Name Social Security No* Street Address Employing Office City State and ZIP Code Marital Status Finance Number Single Married I certify that I live in the state/district of and that no state income tax is being withheld from my pay. I hereby request and authorize withholding from my pay to the said state/district for payment of income tax. It will be used to withhold state taxes from your wages. As a routine use this information may be disclosed to an appropriate law enforcement agency for investigative or prosecution proceedings to a congressional office at your request to the OMB for review of private relief legislation and where pertinent in a legal proceeding to which the Postal Service is a party. Completion of this form is voluntary however if this information is not provided state taxes will be withheld from your wages at the maximum rate. U*S* Postal Service Request for State Income Tax Withholding Name Social Security No* Street Address Employing Office City State and ZIP Code Marital Status Finance Number Single Married I certify that I live in the state/district of and that no state income tax is being withheld from my pay. I hereby request and authorize withholding from my pay to the said state/district for payment of income tax. It will be used to withhold state taxes from your wages. As a routine use this information may be disclosed to an appropriate law enforcement agency for investigative or prosecution proceedings to a congressional office at your request to the OMB for review of private relief legislation and where pertinent in a legal proceeding to which the Postal Service is a party. Completion of this form is voluntary however if this information is not provided state taxes will be withheld from your wages at the maximum rate.

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