Form Oa - Domestic Form - 2002 Page 2

FORM 132 – DOMESTIC – 2002

:

BUSINESS NAME

Business Identification Number

UNEMPLOYMENT INSURANCE

OREGON ANNUAL WAGE DETAIL REPORT

Date Received

1. TOTAL SUBJECT ANNUAL WAGE _____________

Total must equal the total wages for all four quarters. Use this total for line 1A Form OA.

2. Social Security

3. Name of Employee

1ST QUARTER

2ND QUARTER

3RD QUARTER

4TH QUARTER

Number

Ending March 31

Ending June 30

Ending Sept 30

Ending Dec 31

Initial

Last Name

4.Hours

5.Wages

4.Hours

5.Wages

4.Hours

5.Wages

4.Hours

5.Wages

6. Total Wages For The Quarter(s)

NOTE: All annual employers must complete this page. Failure to report all employees with correct Social Security numbers or failure to accurately report whole hours worked may result in penalties. Data entered on this form must be entered exactly

where designated on this form. Submitting reports not in correct format may result in penalties. To order additional Form 132 Annual Wage Detail Reports call (503) 947-1488 opt. 3.

Form 132 Domestic Annual (10-02)