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Form W-4 (2006). Summary: This is an example of Form W-4 (2006) with items included as described in the text. Additionally, these line items are completed:

1. Type or print your first name and middle initial” field contains John M.
Last name” field contains Green
Home address (number and street or rural route)” field contains 28 Fairway
City or town, state, and ZIP code” field contains Anytown, State 00000
2. Your social security number” field contains 444-00-4444
3. Married” checkbox checked
Employee's signature (Form is not valid unless you sign it.)” field contains John M. Green
Date” field contains January 4, 2006