Form 21e - Quarterly Report

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FORM 21E (Rev. 1/99)
South Dakota Department of Labor
Unemployment Insurance Division
Employer Account Number
Rate
PO Box 4730
Aberdeen, SD 57402-4730
Employer Name
Address
Quarter
Quarter
Quarter
Quarter
3/31
6/30
9/30
12/31
Social Security #
Employee Name
Total Wages
Excess Wages
Total Wages
Excess Wages
Total Wages
Excess Wages
Total Wages
Excess Wages
Quarter Totals

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