Form Dol-3c Report To Add New Wages And/or Correct Reported Wages

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Electronic Form Processing - DO NOT STAPLE OR SUBMIT COPIES - Use Black Ink
DOL - 3C
(R-8/05)
*00301*
REPORT TO ADD NEW WAGES
GEORGIA
DEPARTMENT OF LABOR
AND/OR CORRECT REPORTED WAGES
00301
Mail Completed Form To:
For Department Use Only
GDOL - EMPLOYER ACCOUNTS, Room 768
148 Andrew Young International Blvd., N.E.,
Atlanta, GA 30303-1751
M M
D D
Y Y Y Y
/
/
Phone: (404) 232-3245
SECTION A
-
.
Q
Y Y Y Y
M M
D D
Y Y Y Y
/
/
/
SECTION B
PLEASE INCLUDE YOUR DOL
ACCOUNT NUMBER ON ALL CHECKS
AND CORRESPONDENCE
SECTION C
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
Totals
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
SECTION D
.
.
,
,
,
,
.
.
,
,
,
,
.
.
,
,
,
,
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
SECTION E
(
)
_______________________________
________________________
____________
_______________________

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