HTML:
<table>
<tr class = "form">
<td class = "letter"><b>A</b></td>
<td class = "question">Enter "1" for yourself if no one else can claim you as a dependent</td>
<td class = "form">
<select onchange="sum()" id = "A" name="personal_allowance_a" >
<option value="0">0</option>
<option value="1">1</option>
</select>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>B</b></td>
<td class = "question">Enter "1" if:
<ul>
<li> You are single and have only one job; or </li>
<li> You are married, have only one job, and your spouse does not work; or </li>
<li> Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less.</li>
</ul>
</td>
<td class = "form">
<select onchange="sum()" id = "B" name="personal_allowance_b" >
<option value="0">0</option>
<option value="1">1</option>
</select>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>C</b></td>
<td class = "question">Enter "1" for your$[SP]<b>spouse</b>. But, you may choose to enter "-0-" if you are married and have either a working spouse or more than one job. (Entering "-0-" may help you avoid having too little tax withheld.)
</td>
<td class = "form">
<select onchange="sum()" id = "C" name="personal_allowance_c" >
<option value="0">0</option>
<option value="1">1</option>
</select>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>D</b></td>
<td class = "question">Enter number of$[SP]<b>dependents</b>$[SP](other than your spouse or yourself) you will claim on your tax return
</td>
<td class = "form">
<input type="text" id="D" name ="personal_allowance_d" maxlength="2" size="2" value="0" onchange="sum()"></input>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>E</b></td>
<td class = "question">Enter "1" if you will file as$[SP]<b>head of household</b>$[SP]on your tax return (see conditions under$[SP]<b>Head of household</b>$[SP]above)
</td>
<td class = "form">
<select onchange="sum()" id = "E" name="personal_allowance_e" >
<option value="0">0</option>
<option value="1">1</option>
</select>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>F</b></td>
<td class = "question">Enter "1" if you have at least $2,000 of$[SP]<b>child or dependent care expenses</b>$[SP]for which you plan to claim a credit<p>(<b>Note:</b>$[SP]Do$[SP]<b>not</b>$[SP]include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) </p>
</td>
<td class = "form">
<select onchange="sum()" id = "F" name="personal_allowance_f" >
<option value="0">0</option>
<option value="1">1</option>
</select>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>G</b></td>
<td class = "question"><b>Child Tax Credit</b>$[SP](including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
<ul>
<li>If your total income will be$[SP]<b>less</b>$[SP]than $70,000 ($100,000 if married), enter "2" for each eligible child; then less "1" if you have two to four eligible children or$[SP]<b>less</b>$[SP]"2" if you have five or more eligible children.</li>
<li>If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter "1" for each eligible child</li>
</ul>
</td>
<td class = "form">
<input type="text" id="G" name ="personal_allowance_g" maxlength="1" size="1" value="0" onchange="sum()"/>
</td>
</tr>
<tr class = "form">
<td class = "letter"><b>H</b></td>
<td class = "question">Add lines A through G and enter total here. (<b>Note:</b>$[SP]This may be different from the number of exemptions you claim on your tax return.)
</td>
<td class = "form">
<input type="text" id="H" name ="personal_allowance_h" maxlength="2" size="2"/>
</td>
</tr>
</table>
