Payment Voucher Template - New Hampshire Employment Security

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PAYMENT VOUCHER
New Hampshire Employment Security
REPORT OF EARNINGS FOR LESS THAN FULL-TIME WORK
Note: Please print all information in ink. Wages must be reported on a calendar week basis.
SEE INSTRUCTIONS ON REVERSE SIDE
Print your name:
SSN:
Week Beginning Sunday (mo./day/yr):
And Ending Saturday (mo./day/yr):
Gross Earnings for hrs. worked (before taxes & deductions, including tips): $
Employer’s Name:
Employer’s. tel #:
Gross Earnings for work in self-employment, and/or casual labor/odd jobs: $
Your Signature:
Today’s Date:
DES 1060 R-11/21/02 sd
PAYMENT VOUCHER
New Hampshire Employment Security
REPORT OF EARNINGS FOR LESS THAN FULL-TIME WORK
Note: Please print all information in ink. Wages must be reported on a calendar week basis.
SEE INSTRUCTIONS ON REVERSE SIDE
Print your name:
SSN:
Week Beginning Sunday (mo./day/yr):
And Ending Saturday (mo./day/yr):
Gross Earnings for hrs. worked (before taxes & deductions, including tips): $
Employer’s Name:
Employer’s. tel #:
Gross Earnings for work in self-employment, and/or casual labor/odd jobs: $
Your Signature:
Today’s Date:
DES 1060 R-11/21/02 sd
PAYMENT VOUCHER
New Hampshire Employment Security
REPORT OF EARNINGS FOR LESS THAN FULL-TIME WORK
Note: Please print all information in ink. Wages must be reported on a calendar week basis.
SEE INSTRUCTIONS ON REVERSE SIDE
Print your name:
SSN:
Week Beginning Sunday (mo./day/yr):
And Ending Saturday (mo./day/yr):
Gross Earnings for hrs. worked (before taxes & deductions, including tips): $
Employer’s Name:
Employer’s. tel #:
Gross Earnings for work in self-employment, and/or casual labor/odd jobs: $
Your Signature:
Today’s Date:
DES 1060 R-11/21/02 sd

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