Form Dws-Ark-209b - Employer'S Quarterly Contribution And Wage Report Page 2
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1
2CONTINUATION SHEET FOR FORM 209B
DWS ID Number ___________________________________
Quarter End Date _____________________
Employer ____________________________________________________________
Town
_________________________________________
Page ________ of ________
SOCIAL SECURITY NUMBER
FIRST NAME, MIDDLE INITIAL & LAST NAME OF EMPLOYEE
TOTAL WAGES PAID
1 )
$
.
2 )
$
.
3 )
$
.
4 )
$
.
5 )
$
.
6 )
$
.
7 )
$
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8 )
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$
9 )
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$
10 )
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$
11 )
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$
12 )
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$
13 )
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$
14 )
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$
15 )
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$
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$
17 )
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$
18 )
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$
19 )
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$
20 )
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$
21 )
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$
22 )
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$
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$
24 )
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$
25 )
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$
26 )
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$
$
.
TOTAL WAGES FOR THIS PAGE
DWS-ARK-209C
(REV. 06-06)
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