Form Dol-4n - Employer'S Quarterly Tax And Wage Report Form
ADVERTISEMENT
1
2EMPLOYER'S QUARTERLY TAX AND WAGE REPORT - PART I
* 4 3 9 9 9 *
GEORGIA DEPARTMENT OF LABOR<- P.O. BOX 740234 - ATLANTA, GA 30374-0234 Tel. (404) 232-3001
*43999*
REPORT FOR THE QUARTER ENDING
Attach any wage sheets
to this page.
Use
ink only.
BLACK
DOL Account Number
Qtr/Yr
Total Tax Rate Form must be Filed By
Parts I & II of this report must
always be submitted. Enter zeroes
in
if no
TOTAL GROSS WAGES PAID THIS QUARTER
wages were paid for this quarter.
1. Social Security Number
2. Employee's Name
3. Total Individual Wages
Paid This Quarter
Last
FI
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
.
$
,
,
.
PAGE
OF
WAGE SHEETS
TOTAL WAGES
$
FOR THIS PAGE
,
,
TOTAL GROSS WAGES
.
$
PAID THIS QUARTER
(Enter this amount on PART II, Line 2)
MESSAGE AREA
DOL-4N (R-6/04)
EL3103
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial