Employer'S Quarterly Wage & & Contribution Report - Vermont Department Of Labor Page 2
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2VERMONT EMPLOYER'S QUARTERLY WAGE REPORT
EMPLOYER NO.
QUARTER ENDING DATE
EMPLOYER NAME
VERMONT DEPARTMENT OF LABOR • Attn: Employer Services • P.O. Box 488 • Montpelier, VT 05601-0488 • Phone (802) 828-4344
INDIVIDUAL EMPLOYEE WAGE DATA FOR THIS QUARTER (Please type or print entries)
3. TOTAL GROSS WAGES
1. SOCIAL SECURITY
2. EMPLOYEE'S NAME
5. HOURLY
6. GENDER
4. H/S
NUMBER
(LAST, FIRST, MIDDLE INITIAL)
PAID THIS QUARTER
RATE
M / F
TOTAL WAGES
7. PAGE _____ of _____
THIS PAGE
THIS REPORT PAGE MUST BE RETURNED WITH A PROPERLY SIGNED AND DATED
QUARTERLY WAGE & CONTRIBUTION REPORT (FORM C-101)
C-147 WEB (1/06)
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