Alaska Quarterly Contribution Report Form - 2001 Page 2
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1
2Alaska Quarterly Contribution Report
THE 2002 TAXABLE WAGE BASE FOR EACH EMPLOYEE IS $ 26,000.
Quarter Ending:
Due Date:
Employer Account No:
If None enter "0"
FEIN:
1. For each month, report the number
st
nd
rd
1
2
3
of workers who worked during or
Month
Month
Month
received pay for the payroll period,
th
which includes the 12
of the month.
2. Total Reportable wages paid this
quarter. (See Instructions, page 2)
$
3. Less excess wages over the taxable
wage base.
($
)
AGENCY USE ONLY
4. Wages reported to other states? See
instructions explaining this on page 2.
o
Yes
5. Taxable wages paid this quarter.
$
A report must be filed even if no wages are
Employer's Rate
paid for the quarter.
6. Employer's Contribution
$
%
Employee's Rate
To amend your quarterly report, please submit a
7. Employee's Contribution
$
“Correction of Wage Item Form 1462-A”.
.50
%
Total Rate
8. Total Contributions Due
$
To obtain Form 1462-A, call 1-888-448-3527 or
%
download the form from our web site located at
9. Prior Balance as of
$
10. Amount Remitted
$
FOLD IN HALF
NO CHECK STUBS PLEASE
FOLD IN HALF
FOLD IN HALF
NO CHECK STUBS PLEASE
FOLD IN HALF
WAGE SCHEDULE
* See Area Map for Geographic Location Codes
11. Employee's
12. Employee's Name - Type or Print
13. Reportable wages
14. Full
15.
(Do not list employees more than once.)
Social Security
paid this quarter.
Occupational
Geographic
Last
First
MI
Number
(No negative wages)
Title or Code
Code *
S
T
A
P
L
E
C
H
E
C
K
S
H
E
R
Make checks payable to the
16. Total Number of Pages
17. Total Reportable Wages - All Pages
E
Alaska Department of Labor and Workforce Development
(Same Total as in Block 2 above.)
If you have any questions,
call toll free 1-888-448-3527
I hereby certify that the information on this report is true and correct.
Signed: ________________________________________________ Title: ________________________________ Date: ________________
Printed Name: _____________________________________________ Contact Telephone Number: ( _
_ )________________________
Alaska Department of Labor & Workforce Development, Employment Security Tax, PO Box 25506, Juneau, AK 99802-5506
TCONTC 1004-3a (12/01)
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