Form Lwc Es51/web - Quarterly Wage & Tax Report - Amendment
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1QUARTERLY WAGE & TAX REPORT - AMENDMENT FORM (LWC ES51/WEB)
This form can be mailed or faxed to the UI Tax Accounting/Adjustment Department at (225) 346-6071
Questions regarding this form may be directed to the UI Tax Accounting/ Adjustments Unit at (225) 342-2961
1. STATE ID. NO.
2. FEDERAL I. D. #
3. YEAR / QUARTER
4. EXPERIENCE RATE %
This form is used to correct errors made on previously
5. EMPLOYER NAME, D.B.A. & ADDRESS
filed quarterly reports. Please print and review the
instructions for completing this form prior to entering
any data.
6. Wages as Originally Reported
7. Wages as Amended
ORIGINAL TOTAL WAGES
AMENDED TOTAL WAGES
ORIGINAL EXCESS WAGES
AMENDED EXCESS WAGES
ORIGINAL TAXABLE WAGES
AMENDED TAXABLE WAGES
$
$
CONTRIBUTIONS PAID
AMENDED CONTRIBUTIONS DUE
11. REASON FOR AMENDMENT:
8. Amount overpaid
$
9. Amount underpaid
$
10. Amount of remittance
( MAKE CHECKS PAYABLE TO THE OFFICE OF UI Administration. DO NOT SEND CASH OR CHANGE)
If you have overpaid and the overpayments are less than or equal to $500, the tax overpayment will print on the next
quarterly report due. A Tax Overpayment notice will be issued prior to the due date of the next quarterly report due if the
amount exceeds $500. If the account is no longer active, a refund will be issued automatically. If you have underpaid, include
interest and penalty due in the total remittance. Interest is calculated at 1% per month, or a percentage thereof. Penalty is
calculated at 5% per month not to exceed 25%. A Tax Delinquent notice will be issued if the underpayment is not paid in full.
COMPLETE THIS SECTION IF EMPLOYEE WAGES HAVE INCREASED OR DECREASED
12. SOCIAL SECURITY NO.
13. EMPLOYEE NAME
14. ORIGINAL TOTAL WAGES
15. AMENDED TOTAL WAGES
Use the Continuation sheet for Amended Wages to list
0
0
additional employees .
Total
Total
MAIL TO:
I CERTIFY THE INFORMATION GIVEN IS TRUE AND CORRECT.
LOUISIANA WORKFORCE COMMISSION
(Unsigned amended forms will not be processed)
OFFICE OF MANAGEMENT & FINANCE
ADJUSTMENTS UNIT
16. SIGNATURE:
DATE:
P.O. BOX 94100
BATON ROUGE, LOUISIANA 70804
TITLE:
PHONE:
LWC-ES51/web
Rev. 04/12
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