Form K-Cns 010 - Employer Status Report - Kansas Department Of Labor Page 2
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3KANSAS DEPARTMENT OF LABOR
Page 2 of 4
K-CNS 010 (Rev. 09-10)
13. Address where accounting records are maintained/can be examined in the State of Kansas:
Address same as # 12:
Street Number
Direction
Street Name
Apt/Suite No
City
State
Zip + 4
14. Company or in-house payroll contact:
Phone Number
First Name
MI
Last Name
Address same as # 12:
E-Mail
Street Number/PO Box
Direction
Street Name
Apt/Suite No
City
State
Zip + 4
15.
Ownership identification - Owner, Corporate Officer, Member, Member/Manager, Partner (general & limited), etc. Use full LEGAL names.
Do NOT use nicknames. Provide residence address of each owner, officer, partner, etc. Attach separate sheet(s) if additional space is needed.
Social Security Number
Title
First Name
MI
Last Name
Street Number
Direction
Street Name
Apt/Suite No
City
State
Zip + 4
Social Security Number
Title
First Name
MI
Last Name
Street Number
Direction
Street Name
Apt/Suite No
City
State
Zip + 4
Social Security Number
Title
First Name
MI
Last Name
Street Number
Direction
Street Name
Apt/Suite No
City
State
Zip + 4
16. Record all Kansas wages paid by calendar quarter for the current and the prior calendar year.
Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
YYYY
Dollars and Cents
Dollars and Cents
Dollars and Cents
Dollars and Cents
UNEMPLOYMENT INSURANCE CONTRIBUTIONS
P.O. Box 400, Topeka, KS • phone (785) 296-5027 • fax (785) 291-3425
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