Transcription of Collection Information Statement for Individuals
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Collection Information Statement for Individuals
FormMD 433-A(Rev. July 2000)State of MarylandComptroller of MarylandNote: Complete all blocks, except shaded areas. Write N/A (not applicable) in those blocks that do not Taxpayer(s) name(s) and address2 Home phone number3 Marital status ( )4a Taxpayer s Social Security number4b Spouse s Social Security numberCounty_____Section IEmployment Information5 Taxpayer s employer or businessa How long employedb Business phone numberc Occupation (name and address)d Number of exemptionse Pay period:! Weekly! Bi-weeklyf (Check appropriate box) claimed on W-4! Monthly! _____ ! Wage earner ! Sole proprietor Payday: _____ (Mon-Sun) ! Partner6 Spouse s employer or businessa How long employedb Business phone numberc Occupation (name and address)d Number of exemptionse Pay period:!
Form MD 433-A (Rev. 7-2000) Page 2 Section III (continued) General Financial Information 14 Charge cards and lines of credit from …
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