Form K-Cns 111 - Employer Adjustment To Quarterly Wage Report
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6KANSAS DEPARTMENT OF LABOR
EMPLOYER ADJUSTMENT TO
RETURN TO:
Examining Unit
Kansas Department of Labor
QUARTERLY WAGE REPORT
401 SW Topeka Boulevard
Topeka, KS 66603-3182
If no tax is due
K-CNS 111 (Rev. 9-2009)
FAX TO:
785-291-3425
TYPE OR PRINT CLEARLY
INSTRUCTIONS: K-CNS 111 is used to amend a previously filed "Quarterly Wage Report & Unemployment Tax Return, K-CNS 100". Complete this form and send the original
to the address listed above, keep a copy for your records. If you have questions regarding the completion of this report, you may call your nearest unemployment tax
representative or the Examining Unit in Topeka at 785-296-5027. This is not a toll-free call. You may also e-mail to uitax@dol.ks.gov. Further instructions are on page 2.
1. Employer Name and Address
2. Quarter
3. Reason for Adjustment
Year
%
7.
4. Account Number
5. Rate
6. Page
of
Pages
Signature
Date
Total Wages
Excess Wages
8. Social Security
9. Name
10.
11.
Number
(Last, First, M.I.)
10.a
Reported
10.b
Correct
11.a
Reported
11.b
Correct
Total - This page
$0.00
$0.00
$0.00
$0.00
Total - Continuation Sheets
$0.00
$0.00
$0.00
$0.00
12. Grand Total
AGENCY USE
$0.00
$0.00
$0.00
$0.00
12.a
12.b
12.c
12.d
13. Total Wage Difference
0.00
. . . . . . . . . . . . . .
AGENCY USE
Deposit
14. Excess Wage Difference
Date Received
. . . . . . . . . . . .
0.00
Code 13
15. Net Difference Taxable Wages
. . . . . . . .
0.00
Code 14
16. Tax Due or Overpaid
0.00
. . . . . . . . . . . . . . . .
Contri.
Underpayment
Overpayment
UNEMPLOYMENT TAX CONTRIBUTIONS
401 SW Topeka Blvd, Topeka KS 66603-3182
Phone 785-296-5027
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