Employer'S Contribution And Payroll Report Form - Iowa Workforce Development - 2007 Page 4
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4Employer's Payroll Continuation Sheet
Iowa Account
60-0103
(2007)
Qtr
Year
Number
Iowa Workforce Development - Attn: Tax Bureau
1000 East Grand Avenue
Des Moines IA 50319-0209
Telephone (515) 281-5339
Employer Name & Address
INSTRUCTIONS FOR USE:
Use the blank form as a master to make additional copies of
the continuation sheet. Submit the completed original along
with your quarterly Employer's Contribution & Payroll Report
to Iowa Workforce Development.
Location
First Name
MI
16. Social Security Number
17. Last Name
18. Total Wages Paid
19. Taxable Wages Paid
Code
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
000
20. Totals For This Page
13. Page ___ of ___
Rev. 2007
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