Form Wvuc-A-154-A - West Virginia Unemployment Compensation
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1WVUC-A-154-A
Rev. 8-09
West Virginia Unemployment Compensation
WAGE REPORT - YOUR QUARTERLY CONTRIBUTION REPORT MUST ACCOMPANY THIS FORM
See more instructions on separate sheet.
MUST BE TYPEWRITTEN OR PRINTED IN BLACK INK IN ALL CAPITAL LETTERS. DO NOT PRINT COMMAS, DECIMALS OR $ SIGNS.
3) FOR CALENDAR QTR
1) EMPLOYER NAME & ADDRESS
2) EMPLOYER NUMBER
4) DUE DATE
Office
5) EMPLOYEE’S SOC. SEC. NO.
6) ENTER EMPLOYEE’S
7) EMPLOYEE’S GROSS WAGES
FIRST
M
Only
LAST NAME
INITIAL
Total wages paid this quarter including
cents
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8) TOTAL NUMBER EMPLOYEES
9) TOTAL WAGES ON ENTIRE REPORT
10) TOTAL WAGES ON THIS PAGE
ON ENTIRE REPORT
11) PAGE ________ OF _________
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