Transcription of QUARTERLY CONTRIBUTION RETURN AND REPORT OF …
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QUARTERLY CONTRIBUTION RETURN AND REPORT OF …
DE 9C Rev. 1 (1-12) (INTERNET)Page 1 of 2D. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERD. SOCIAL SECURITY NUMBERE. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)E. EMPLOYEE NAME (FIRST NAME)( )( )( )( )( )( )( )(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)(LAST NAME)Check this box if you are reporting ONLY Voluntary Plan Disability Insurance wages on this Personal Income Tax (PIT) Wages and PIT Withheld, if appropriate. (See instructions for Item B.) NOT ALTER THIS AREAA. EMPLOYEES full-time and part-time who worked duringor received pay subject to UI for the payroll period whichincludes the 12th of the month.
Visit EDD’s Web site at www.edd.ca.gov MAIL TO: State of California / Employment Development Department / P.O. Box 989071 / West Sacramento CA 95798-9071 O. I declare that the information herein is true and correct to the best of my knowledge and belief. L. GRAND TOTAL SUBJECT WAGES M. GRAND TOTAL PIT WAGES N. GRAND TOTAL PIT WITHHELD
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