ANNUAL PAYROLL TAX RETURN FOR
EMPLOYER OF HOUSEHOLD WORKERS
FOR THE YEAR 2000
APPROVED EXTENSION TO: ________________________
PLEASE TYPE ALL INFORMATION
DELINQUENT IF
YEAR
NOT POSTMARKED
2000
YEAR ENDED ___________________ DUE _______________________ OR RECEIVED BY
________________________
EMPLOYER ACCOUNT NO.
DO NOT ALTER THIS AREA
P1
P2
C
P
U
S
A
Mo.
Day
Yr.
EFFECTIVE
=
=
=
DATE
NO WAGES THIS YEAR
DETAILED INSTRUCTIONS ARE
CHECK BOX
FINAL RETURN
IF:
LOCATED ON PAGE 2
REVERT TO QUARTERLY
A. TOTAL SUBJECT WAGES PAID THIS CALENDAR YEAR------------------------------------------------------------->
WAGES
UI %
B. EMPLOYER’S UNEMPLOYMENT INSURANCE (UI) TAXES
(B1)
(B2)
(B3)
X
=
$0.00
(Total Employee Wages up to $7000 per employee per calendar year)
(multiplied by)
WAGES
ETT %
C. EMPLOYMENT TRAINING TAX (ETT)
(C1)
(C2)
(C3)
X
$0.00
(Total Employee Wages up to $7000 per employee per calendar year)
(multiplied by)
D. EMPLOYEE STATE DISABILITY INSURANCE (SDI) TAXES
(Total Employee Wages up to a maximum limit of $46,327 per employee for 2000)
WAGES
SDI %
(D1)
(D2)
(D3)
X
=
(SDI Taxable Wages paid from 01/01/00 to 03/31/00 up to the maximum)
0.005
$0.00
(multiplied by)
WAGES
SDI %
(D4)
(D5)
(D6)
X
=
(SDI Taxable Wages paid from 04/01/00 to 12/31/00 up to the maximum)
0.007
$0.00
(multiplied by)
E. CALIFORNIA PERSONAL INCOME TAX (PIT) WITHHELD------------------------------------------------------------>
(Total PIT withheld per Forms W-2)
F. TOTAL TAXES DUE (Add Items B3, C3, D3, D6, and E) --------------------------------------------------------------->
$0.00
G. LESS VOLUNTARY PREPAYMENT OF TAXES MADE DURING THE YEAR ------------------------------------>
H. BALANCE OF TOTAL TAXES DUE ------------------------------------------------------------------------------------------->
$0.00
INCLUDE EMPLOYER ACCOUNT NUMBER ON YOUR CHECK. Do not staple check to return.
Make check payable to EMPLOYMENT DEVELOPMENT DEPARTMENT
I.
Be sure to sign this declaration: I declare that the information herein is true and correct t the best of my knowledge and belief.
Signature ___________________________________Title ___________________________Phone ( _____ ) ________________ Date _________________
(Owner, Accountant, Preparer, etc.)
_______________________________________________________________________________________________________________________________________________________________________________
DE 3HWX (1-01) (INTERNET)
P.O. Box 826221 • Sacramento, CA 94230-6221
CU
Page 1 of 2