State or Local Income Tax Worksheet

The State/Local Income Tax Worksheet provides most of the information that you need to fill out your state’s quarterly income tax form. The state and local form corresponds to the Internal Revenue Service Form 941, Employer’s Quarterly Federal Tax Return.

The worksheet contains both states and localities. The name of the form on which you submit this information varies from state to state.

The worksheet displays more than one listing for employees who had income tax withheld for more than one state or locality. When you complete your state’s quarterly tax return, be sure to fill in only those gross wages and withholding amounts that apply to a given state or locality.

How To Use this Worksheet

Enter the information from the worksheet in the appropriate space on your state form:

Worksheet	State Form
Employee’s name and Social Security number	Employee’s name and Social Security number
Gross pay per quarter (for each employee)	Gross wages paid this quarter
Total gross pay for this quarter	Total gross wages reported or paid
401(k) and 125/Cafeteria withholdings	401(k) and 125/Cafeteria withheld
Tax withholdings	State or local tax withheld

Multiple Companies

If you use multiple companies, this report may contain employee data for one or more companies that are associated with the employee.