Form K-Cns 111 - Employer Adjustment To Quarterly Wage Report Page 4
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63rd Continuation Sheet
Kansas Department of Labor
EMPLOYER ADJUSTMENT TO QUARTERLY WAGE REPORT
K-CNS 111 (Rev. 9-2009)
Employer
Rate
Account Number
Quarter / Year
%
/
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
12. Totals . . . .
$0.00
$0.00
$0.00
$0.00
12.a
12.b
12.c
12.d
UNEMPLOYMENT TAX CONTRIBUTIONS
401 SW Topeka Blvd, Topeka KS 66603-3182
Phone 785-296-5027
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