Form De 678 - Tax And Wage Adjustment Form - 2004

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STATUTE OF LIMITATIONS
A claim for refund or credit must
TAX AND WAGE ADJUSTMENT FORM
be filed within three years of the
last timely filing date of the year
being adjusted
SECTION I:
EMPLOYER ACCOUNT NO.
BUSINESS NAME
TAX YEAR
ADDRESS
CITY, STATE, ZIP
REASON FOR ADJUSTMENT __________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
SECTION II: REQUEST FOR REFUND OF OVERPAYMENT ON PAYROLL TAX DEPOSIT. Provide the following information
and complete Items B through H in Section III, with correct deposit information.
PAYROLL DATE
YEAR
QTR
AMOUNT PREVIOUSLY PAID
$
M
M
D
D
Y
Y
YY
Q
SECTION III: REQUEST FOR REFUND OR ANNUAL RECONCILIATION RETURN ADJUSTMENTS
>
A. TOTAL SUBJECT WAGES PAID THIS CALENDAR YEAR .....................................................
(A)
B. UNEMPLOYMENT INSURANCE (UI) TAXES
UI TAXABLE WAGES
UI CONTRIBUTIONS
UI RATE
%
X
=
(B)
0.00
ETT CONTRIBUTIONS
C. EMPLOYMENT TRAINING TAX (ETT) RATE OF
%
X
UI TAXABLE WAGES
=
(C)
0.00
D. STATE DISABILITY INSURANCE (SDI) TAXES
(includes Paid Family Leave amount)
SDI TAXABLE WAGES
SDI EMPLOYEE CONTRIBUTIONS WITHHELD
SDI RATE
%
X
=
(D)
0.00
PIT WITHHELD PER FORMS W-2 AND/OR 1099R
>
E. CALIFORNIA PERSONAL INCOME TAX (PIT) WITHHELD ....................................................
(E)
>
F. SUBTOTAL (Add Items B, C, D and E) ....................................................................................
0.00
(F)
>
G. LESS: TOTAL TAXES PAID FOR THE YEAR OR ON DE 88 .................................................
(G)
(DO NOT INCLUDE PENALTY AND INTEREST PAYMENTS)
SDI not refunded to the employee(s)
>
H.
........................
LESS: ERRONEOUS SDI CONTRIBUTIONS NOT REFUNDED TO THE EMPLOYEE(S)
(H)
(COMPLETE SECTION IV).
I.
TOTAL TAXES DUE OR OVERPAID (ITEM F MINUS ITEM G AND ITEM H)
>
0.00
IF TAXES ARE DUE, SUBMIT PAYMENT WITH THIS FORM. ……………….………………………………….
(I)
IF SDI OR PIT WITHHOLDINGS ARE OVERPAID, COMPLETE SECTION IV.
Complete reverse side of this form if the adjustment changes what you reported on the Quarterly Wage and Withholding Report (DE 6)
SECTION IV: STATE DISABILITY INSURANCE (SDI) AND CALIFORNIA PERSONAL INCOME TAX (PIT) OVERPAYMENTS
SDI and PIT deductions are employee contributions. The EDD cannot refund these contributions to you unless you first refund the erroneous
deductions to the employee(s).
SDI deductions
PIT deductions
1. Was the overpayment withheld from the wages of employee(s)?
Yes
No
Yes
No
If no, no further information is required in this Section.
2. If yes, was this amount refunded to the employee(s)?
Yes
No
Yes
No
• If the overpayment has not been refunded because employee(s) are no longer employed and you are unable to locate, EDD will need further
information. On a separate page list: Social Security Number, employee(s) name, last known address, and amount of SDI not refunded.
• If you have not issued W-2s, EDD will allow PIT wage and withholding credit adjustments. Please enter changes in Section V.
If you have issued W-2s, the employee will receive a credit for the PIT overwithholdings when filing his/her California Income Tax Return (Form 540)
with the Franchise Tax Board. Do not refund PIT overwithholdings to the employee. Do not change the California PIT withholding amount shown on
the Form W-2. Do not file a claim for refund with EDD. For additional information see Instruction Sheet (DE 678-I), Section IV.
Signature
Title
Phone (
)
Date
(Owner, Accountant, Preparer, etc.)
DE 678 Rev. 2 (4-04) (INTERNET) SIGN AND MAIL TO: P.O. Box 826286 / Sacramento CA 94230-6286
CU
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