Form 65-5300 - Employer'S Contribution And Payroll Report Form - Iowa Workforce Development - 2006 Page 2
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2Employer's Payroll Continuation Sheet
60-0103 (2006)
Iowa Workforce Development
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Attn: Tax Bureau
Page __________ of ________
1000 East Grand Avenue - Des Moines, Iowa 50319-0209
Telephone (515) 281-5339
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Employer Name & Address
Iowa Account Number
Quarter & Year
Taxable Wages Paid
Social Security Number
Last Name
First Name
MI
Total Wages Paid
This form is available at no cost to the public from Iowa Workforce Development.
Totals For This Page
USE THIS FORM AS A MASTER TO MAKE ADDITIONAL COPIES OF BLANK CONTINUATION SHEETS. SEND
PREPARED ORIGINAL TO IOWA WORKFORCE DEVELOPMENT. KEEP A PHOTOCOPY FOR YOUR FILES.
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