Form De 2251a - Affidavit Of Mailing printable pdf download

Form De 2251a - Affidavit Of Mailing

AFFIDAVIT OF MAILING

Please read instructions on reverse side prior to completion of this form.

Account No. __________________________________ Business Name ________________________________________

I, __________________________________________ , declare that on __________________________19 ____________ .

(Print Name)

(Date)

I mailed the following document(s):

DE 3BHW, Report of Wages, for quarter ending ___________________________________________________ .

DE 3D, Quarterly Contribution Return (Voluntary Plan), for quarter ending _______________________________ .

DE 3HW, Annual Payroll Tax Return for Employer of Household Workers, for year ending ___________________ .

DE 6, Quarterly Wage and Withholding Report, for quarter ending ______________________________________ .

Magnetic Tape

Paper

DE 7, Annual Reconciliation Return, for the year __________________________________________________ .

DE 88, Payroll Tax Deposit, for the payroll period ending______________________________________________ .

Check No. ______________________ Date __________________________ Amount _____________________ .

Other ______________________________________________________________________________________ .

by placing them in the United States mail box / post office located at:

____________________________________________________________________________________________________ .

The documents were contained in (a) sealed envelope(s) with postage fully prepaid and properly addressed to the

Employment Development Department.

I declare under penalty of perjury that the foregoing is true and correct.

Executed at _________________________________________ , __________ on ________________________ , 19______ .

(City)

(State)

(Date)

____________________________________________

(Signature and title of person who mailed the document[s])

____________________________________________

(Business Address)

____________________________________________

(City)

State)

(ZIP Code)

____________________________________________

(Business Phone)

DE 2251A Rev. 16 (3-99) (INTERNET)

P.O. Box 826880 • Sacramento CA 94280-0001

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Form De 2251a - Affidavit Of Mailing