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NEW HAMPSHIRE DEPARTMENT OF EMPLOYMENT SECURITY
45 SOUTH FRUIT ST CONCORD NH 03301-4857 TEL (603) 224-3311
EMPLOYER TAX AND WAGE REPORT (QUARTERLY)
DES 200C R 1/02
PART 2 (WAGES)
CONTINUATION SHEET
STATE EMPLOYER ACCOUNT NUMBER
NAME CONTROL
FOR CALENDAR QUARTER ENDED
EMPLOYER NAME AND ADDRESS
18.
SOCIAL SECURITY
19.
NAME OF EMPLOYEE
20.
TOTAL GROSS WAGES
NUMBER
(LAST NAME, FIRST NAME)
PAID THIS QUARTER
NUMBER EACH CONTINUATION SHEET
22. TOTAL WAGES PAID FOR ENTIRE REPORT (SAME AS
21. WAGE TOTAL FOR THIS PAGE
CONSECUTIVELY BEGINNING WITH PAGE 2.
LINE 8)
ATTACH TO REPORT
PAGE
OF

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