Form Wyo 065 - Payment Coupon
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1Payment Coupon
WYO 065
03 / 05 / 07
●
Business Name
Check #
Quarter/Year
WC Employer #
WC Amount
WC Amount
Due $
Paid $
Total Amount
Check Amount $
Due $
State Use Only
Date Received
Payment Type
Initials
Postmark
Date
●
Return to:
Wyoming Department of Employment
Workers' Safety & Compensation
Employer Services
P O Box 20006
Cheyenne WY 82003
from internet
FISCAL
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Parent category: Legal