Transcription of DWS ID NUMBER DATE QUARTER ENDED …
1 EMPLOYER S QUARTERLY CONTRIBUTION AND WAGE REPORTARKANSAS DEPARTMENT OF WORKFORCE BOX 8007 LITTLE ROCK, arkansas 72203-8007 (501) 682-3798 DWS ID NUMBER date QUARTER ENDED FEDERAL ID NUMBER REPORT DUE date Check box and return if no wages paid cPART A. 1st mo 2nd mo 3rd mo 1. NUMBER of employees in the pay period including the 12th of: of qtr _____ of qtr _____ of qtr _____ 2. Total of all wages paid for personal services, including bonuses/commissions .. $ 3. Wages in excess of (see instructions).
2 $< 4. Out of state wages if employee(s) are paid in multiple states (see instructions) .. $< 5. Taxable wages (subtract item 3 and 4 from item 2, enter results here) .. $ 6. Contribution rate for this reporting period .. _____ 7. Contribution due for this QUARTER (multiply item 5 by ) .. $ 8. Amount of debit or credit from previous quarters .. $ 9. Interest (accrued on all unpaid contributions at the rate of per month) .. $ 10. Penalty (see instructions).
3 $ 11. Total amount due .. $ Amount of remittance (make payable to arkansas Department of Workforce Services) .. $ NAICS AUD COInitialAmt receivedDO NOT ALTER THIS FORMPART the SSN, first name, middle initial, last name andtotal wages paid to each employee during the calendarquarter in the space provided below (continuation sheetprovided).TOTAL NO. OF EMPLOYEESON THIS REPORT _____$.SOCIAL SECURITY NUMBERFIRST NAME, MIDDLE INITIAL & LAST NAME OF EMPLOYEE 1 )$.2 )$.3 )$.4 )$.5 )$.6 )$.7 )$.8 )$.
4 TOTAL WAGES FOR THIS PAGEPAGE ONE OF _____ PAGE(S)I HEREBY CERTIFY THIS REPORT IS TRUE AND CORRECT AND NO PARTS OF THE CONTRIBUTION HAVE OR WILL BE BORNE BYANY _____TITLE _____ date _____ TELEPHONE _____MAINTAIN COPY FOR YOUR RECORDSDWS-ARK-209B(REV. 01-09)ATTACH CHECK HERETOTAL WAGES PAIDCASHIER S STAMPDWS-ARK-209C(REV. 06-06)CONTINUATION SHEET FOR FORM 209 BDWS ID NUMBER _____ QUARTER End date _____Employer _____Town _____ Page _____ of _____$.SOCIAL SECURITY NUMBERFIRST NAME, MIDDLE INITIAL & LAST NAME OF EMPLOYEE 1 )$.
5 2 )$.3 )$.4 )$.5 )$.6 )$.7 )$.8 )$.TOTAL WAGES FOR THIS PAGETOTAL WAGES PAID$.9 )$.10 )$.11 )$.12 )$.13 )$.14 )$.15 )$.16 )$.17 )$.18 )$.19 )$.20 )$.21 )$.22 )$.23 )$.24 )$.25 )$.26 )
