NH EMPLOYMENT SECURITY
ATTN: CASHIER
PO BOX 2058
CONCORD, NH 03302-2058
PHONE: (603) 224-3311
YOU CAN FILE THIS REPORT ONLINE
AT www2.nhes.nh.gov/webtax
EMPLOYER QUARTERLY TAX REPORT
1. EMPLOYER NAME & ADDRESS
2. STATE EMPLOYER NUMBER
3. FOR CALENDAR QUARTER
4. NAME CONTROL
5. DUE DATE
6. FEDERAL ID NUMBER
NO EMPLOYMENT - IF NO EMPLOYMENT WAS FURNISHED
DURING THE QUARTER, ENTER ZEROS ON LINE 8.
See more instructions on separate sheet. Must send back original (no photocopies). Must be typewritten or printed in black ink in all capital letters.
Do not print commas, or $ signs.
1st MONTH
2nd MONTH
3rd MONTH
7.
FOR EACH MONTH, REPORT THE NUMBER OF COVERED WORKERS WHO
WORKED DURING OR RECEIVED PAY FOR ANY PART OF THE PAYROLL
PERIOD WHICH INCLUDES THE 12TH OF THE MONTH. IF NONE ENTER ZERO.
8.
TOTAL GROSS WAGES PAID THIS QUARTER
(MUST AGREE WITH LINE 24)
9.
WAGES PAID THIS QUARTER IN EXCESS OF
$14,000
PER EMPLOYEE THIS YEAR (see instructions)
10.
NET TAXABLE WAGES (SUBTRACT LINE 9 FROM LINE 8)
11.
UNEMPLOYMENT INSURANCE (UI) TAX DUE
UI TAX
(MULTIPLY LINE 10 BY TAX RATE)
RATE
%
12.
ADMINISTRATIVE CONTRIBUTION (AC) DUE
AC
(MULTIPLY LINE 10 BY RATE)
RATE
%
DO NOT INCLUDE THIS AMOUNT WHEN FILING FEDERAL UNEMPLOYMENT TAX RETURN (FUTA)
13.
TOTAL TAX DUE
(ADD LINES 11 AND 12)
14.
IF PAYMENT IS DELINQUENT ADD 1% PER MONTH ON TOTAL TAX DUE
IF REPORT IS DELINQUENT ADD FEE FOR LATE FILING
15.
(10% OF TAX DUE - MINIMUM $25)
16.
17.
PAY THIS AMOUNT (TOTAL LINES 13 THROUGH 16)
(IF UNDER $1.00 NO PAYMENT DUE)
18.
PREPARED BY
SIGNATURE
MAKE CHECK PAYABLE TO: STATE OF NH - UC
PREPARERS TELEPHONE NO. (
)
MAIL CHECK, ORIGINAL COPIES OF BOTH PARTS OF THE REPORT TO:
TAXPAYER
NH EMPLOYMENT SECURITY
AUTHORIZED SIGNATURE
TITLE
DATE
ATTN: CASHIER
PO BOX 2058
ANY BUSINESS CHANGES/CORRECTIONS SHOULD BE MADE ON THE ATTACHED CHANGE NOTICE
CONCORD, NH 03302-2058