Form Es-903c - New Mexico Department Of Workforce Solutions printable pdf download

Form Es-903c - New Mexico Department Of Workforce Solutions

ES-903C (rev 07/01)

DATE RECEIVED:

NEW MEXICO DEPARTMENT OF WORKFORCE SOLUTIONS

P.O. BOX 2281, ALBUQUERQUE NEW MEXICO 87103

(505) 841-8576

STATEMENT TO CORRECT INFORMATION REPORTED ON FORM ES-903A

Form ES903C should be submitted for each quarter requiring correction. Schedule A should include totals for the quarter.

Only wages being corrected should be listed on schedule B (or attach listing with same format).

SCHEDULE A

AS REPORTED

AS CORRECTED

DIFFERENCE

Acct No.:

1. Total Wages (column 12 of ES903A)

2. Deduct excess wages (column 13 of ES903A)

QTR Ending:

3. Taxable wages (item 1 less item 2)

4. Tax Due (item 3 X rate of)

Date Due:

5. Interest due (1% per month after due date)

6. Late report penalty(add $50)

Name:

7. Late payment penalty (add 5% of tax due or

$25 whichever is greater)

Address:

8. Total amount due to NMDOL

9. Total amount actually paid

SCHEDULE B

Wages as they were reported

Corrected Wages

Employee social

Name of Employee

Individual total wages Wages in excess of

security number

paid this quarter

annual taxable base

paid this quarter

annual taxable base

TOTALS

Reasons for Corrections:(Corrections resulting in credit may not be effected without narrative justification)

FOR DEPARTEMENT USE ONLY

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Date:

Batch No.

Authorized Signature/Title

Date:

Processed by:

Form Es-903c - New Mexico Department Of Workforce Solutions

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