Form Dol-4n - Employer'S Quarterly Tax And Wage Report - Georgia Department Of Labor
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2EMPLOYER'S QUARTERLY TAX AND WAGE REPORT - PART I
43999
GEORGIA DEPARTMENT OF LABOR - P.O. BOX 740234 - ATLANTA, GA 30374-0234 Tel. (404) 232-3245
Month
REPORT FOR THE QUARTER ENDING
Additional Wage Sheets
/
Must be in this format.
DOL Account Number
Qtr/Yr
Total Tax Rate
Form Must be Filed By
(Employer's Name)
Parts I & II of this report must
always be submitted. Enter zeroes
(Street Address)
in Total Reportable Gross Wages
Paid This Quarter if no wages
(Street Address)
-
were paid for this quarter.
(City)
(State)
(Zip + 4)
1. Social Security Number
2. Employee's Full Name
3. Total Individual Reportable
Gross Wages Paid This Quarter
Last
First
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PAGE 1 OF 1
WAGE SHEETS
TOTAL WAGES
$
,
.
,
FOR THIS PAGE
TOTAL REPORTABLE GROSS WAGES
,
,
.
$
(Enter this amount on PART II, Line 2...........PAID THIS QUARTER
MESSAGE AREA
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EL3103
DOL-4N (R-1/14)
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