Form Woes-3a - Employers Quarterly Contribution Report Page 3
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3DO NOT STAPLE OR SUBMIT COPIES
WOES - 3 (REV 03/10)
OKLAHOMA EMPLOYMENT SECURITY COMMISSION
Cartridge / Diskette Submitted
EMPLOYERS QUARTERLY CONTRIBUTION REPORT
Cashier: P O Box 52004 Oklahoma City, OK 73152-2004
2. Last Name
1. Employee Social Security Number
First Name
3. Total Wages Paid
4. Taxable Wages Paid
PAGE TOTAL
To obtain scannable "Continuation Sheets", visit website.
0.00
0.00
13.
Monthly count
of all full and part-time workers who worked
0.00
5. TOTAL WAGES PAID
(Item 3, All Pages) . . . . . . . . . . . . . . . . . . . . .
or received pay subject to unemployment insurance for the
payroll period that includes the 12
th
of the month.
0.00
6. TAXABLE WAGES PAID (Item 4, All Pages) . . . . . . . . . . . . . . . . . . . . .
Month 3
Month 1
Month 2
0.0%
7. Contribution Rate for This Calendar Quarter . . . .
.Enter rate as a decimal, Ex. 0.3% = .003
0.00
8. Contributions Due (Taxable Wages #6 x Contributions Rate #7) . . . . . . . .
14. Oklahoma Account Number
16. Qtr / Yr
9.
Interest Due (1% per month after due date) . . . . . . . . . . . . . . . . . . . . . . .
10. 10% Penalty Due $___________ + $100.00 Penalty Due = . . . . . . . . . . . .
15. Federal I.D. No.
17. Due Date
11. Debit or Credit.
0.00
12. PAY THIS AMOUNT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18. Taxable Amount For
2010 is $14,900.00
ENTER AMOUNT OF CHECK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2009 is $14,200.00
2008 is $13,600.00
MAKE CHECK PAYABLE TO:
Oklahoma Employment Security Commission
W003
OFFICIAL USE ONLY
19. Name / Address
I certify this report is correct and that no contribution is paid by any employee.
Signature
____________________________________________________
RESET FORM
(
)
Date
_________________
Contact Phone
_________________________
Contact Name
________________________________________________
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