A
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B
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C
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D
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E
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F
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G
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H
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I
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J
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K
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L
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M
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N
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O
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P
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Q
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R
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S
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T
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U
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V
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W
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X
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Y
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Z
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OTHER
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Directory Results for Total earned income (s W2 must be attached) Column 2 Column 3 Employer Name City 1a 1b 1c 1d 1e 1f 1h (If additional space is required, list on back of form) Total Line 1 Other Cities Tax Withheld (Maximum 1%) McComb Tax Withheld Gross to Total Earned Points - rushartsbiology

Total earned income (s W2 must be attached) Column 2 Column 3 Employer Name City 1a 1b 1c 1d 1e 1f 1h (If additional space is required, list on back of form) Total Line 1 Other Cities Tax Withheld (Maximum 1%) McComb Tax Withheld Gross
Total Earned Income Tax Withheld
Total Earned Points - rushartsbiology