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Get WI FA-4139V 2008-2024

Xemptions claimed 15. Monthly federal income tax withheld 16. Monthly state income tax withheld 17. Social Security 18. Medicare 19. Medical insurance 20. Other insurances 21. Union or other dues 22. Retirement or pension fund 23. Savings plan 24. Credit union 25. Child support or spousal support payments 26. Other deductions: (please specify) 27. 28. Total Monthly Deductions (add lines 14 27) MONTHLY NET INCOME (subtract line 28 from line 13) FA-4139V, 01/08 Financial Disclosure Statement.

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