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Revenue Form 2000 - New Jersey

REPORTING FORMAI:'; (Please choose only 1 qfthefollowing 4 reporting methods). 1. Paper Lists or Printouts: This method can be used fbr reporting several newly hired employees at once. Mail lists to our New Hire Operations Center or fax lists to 800-304-4901. using the following format: PAPERLIST or PRINTOUTS. Federal Employer Identification Number (FEIN): 000112222. Employer Payroll \ddress: 0 Wigit International. Inc. 75 Curbside Lane Somewhere, NJ 08601. SSN First Ml Last Address City State Zip Date of Date of Birth Gender Name Name Hire (Opt) (If Available) (Optional). xxx-xx-xxxx ROBERT C CLARKE 34 PERKINS DR NEWBURN 08652 10/23/97 08/06/59 M. xxx-xx-xxxx ANGELA R SMITH Ill MAIN ST TRENTON NJ 08603 10/06/97 12/03/57 F. xxx-xx-xxxx DAVID J CARBO 12 GREEN ST READING NJ 08127 10/03/97 04/26/66 M. 2. New Hire Reporting form : The attached form can be used to report individual employees and can be pho . tocopied. Refer to it for instructions for completing the required information.

Under penalties of perjury, I declare that I have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belief, it is

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