Form Trd-31109 - Employer'S Quarterly Wage, Withholding And Workers' Compensation Fee Report
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2TRD-31109
*82260200*
Rev. 01/13/2012
STATE OF NEW MEXICO
TAXATION AND REVENUE DEPARTMENT
EMPLOYER'S QUARTERLY WAGE, WITHHOLDING AND
WORKERS' COMPENSATION FEE REPORT
Do not submit payment with this report. Taxes and fees due
Who Must File: Employers who are not required to submit Form ES903, Employer's Quarterly
must be reported and paid using forms ES903, CRS-1 or
Wage and Contribution Report, and pay state unemployment insurance, must file this form.
WC-1. This report is filed for informational purposes only.
This report may be filed online at https://efile.state.nm.us/uls2/Logon.aspx.
The Taxation and Revenue Department collects information for each employee, the gross wages paid, the state tax withheld and workers' compensation
fees collected and remitted to the Department from Form ES903, Employer's Quarterly Wage and Contribution Report, or from Form TRD-31109, Employer's
Quarterly Wage, Withholding and Worker's Compensation Fee Report. Employers who are not required to file Form ES903, must file Form TRD-31109.
Employers submitting these quarterly detail information reports are not required to file annual W2 information to the Department. Submit Form TRD-31109,
to the Taxation and Revenue Department by the last day of the month following the close of the calendar quarter. Taxes or fees due may not be remit-
ted with this report. File this report online at https://efile.state.nm.us/uls2/Logon.aspx. If you cannot file online, mail this report to Taxation and
Revenue Department, P.O. Box 2527, Santa Fe, NM 87504-2527. For assistance call (505) 827-0832.
EMPLOYER'S NAME
QUARTER ENDING
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
DBA
CRS IDENTIFICATION NUMBER
ADDRESS
CITY / STATE / ZIP
RETURN TYPE: Check one.
ORIGINAL
AMENDED
SUPPLEMENTAL
1
Page _______ of ________
If additional space is needed, attach the supplemental
TOTAL NUMBER OF EMPLOYEES
schedule(s) and complete the page number information
Enter the number of covered workers (employees) you employed on the
on each page.
last working day of the calendar quarter. Enter zero if none.
1.
EMPLOYEE SOCIAL
2.
EMPLOYEE NAME
5.
WC FEE DUE
3.
GROSS WAGES FOR
4.
STATE INCOME
SECURITY NUMBER
(Last, first and middle initial)
THIS QUARTER
TAX WITHHELD
Enter total of columns 3, 4 and 5, this page.
Enter total of columns 3, 4 and 5 from this page and all supplemental
pages attached to this quarter's report. Enter zero if none.
I declare that I have examined this return including any accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct and complete.
Print name
Date
Signature of employer or authorized agent
E-mail address
Phone
Title
This report can be filed online at https://efile.state.nm.us/uls2/Logon.aspx.
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