Surety Bond Transmittal Form - State Of New Mexico Department Of Workforce Solutions

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SURETY BOND TRANSMITTAL
Date:_____________________________
Employer #:_____________
Employer Name: ______________________________
DBA:________________________________________
Address:_____________________________________
City________________________St_________Zip_______________
Pursuant to Paragraph (3) of Subsection C of Section 51-1-13 NMSA 1978, as a reimbursable
employer you must execute and file with the New Mexico Department of Workforce Solutions a
surety bond.
Indicate the amount of taxable wages paid each quarter for the preceding year ending December
31. If no wages were paid for the preceding year, estimate the amount of taxable wages you will
pay for the succeeding four calendar quarters from the effective date of election.
QUARTER ENDING
TAXABLE WAGES
MARCH 31
$_________________
JUNE 31
$_________________
SEPTEMBER 31
$_________________
DECEMBER 31
$_________________
TOTAL
$_________________ X 2.0%
=
$_________________amount of surety to be filed
with NMDWS.
In order to satisfy this requirement, you may obtain a bond from your insurance company or you
may post a cash surety deposit.
_____________________________________________
_________________________
Authorized Signature for employer
Date
Rev 07-07
s/n 001-0867

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