QUARTERLY WAGE
AND WITHHOLDING REPORT
PLEASE TYPE THIS FORM PER INSTRUCTIONS ON REVERSE
00060198
You must FILE this report even if you had no payroll. If you had no payroll, complete
Page number _______ of ______
Items C or D and
P.
YR
QTR
DELINQUENT IF
QUARTER
NOT POSTMARKED
ENDED
DUE
OR RECEIVED BY
EMPLOYER ACCOUNT NO.
DO NOT ALTER THIS AREA
P1
C
T
S
W
A
EFFECTIVE DATE
Mo.
Day
Yr.
WIC
A. EmPLOYEEs full-time and part-time who worked during
or received pay subject to UI for the payroll period which
includes the 12th of the month.
1st Mo.
2nd Mo.
3rd Mo.
Check this box if you are reporting ONLY Voluntary Plan DI wages on this page.
C.
NO PAYROLL
D.
OUT OF BUSINESS/FINAL REPORT
B.
Report PIT Wages and PIT Withheld, if appropriate. (See instructions for Item B.)
Date
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
.
.
. . . . . .
.
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
.
. . . . .
.
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
.
.
. . . . . .
.
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
.
. . . . . .
.
.
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
.
. . . . . .
.
.
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
. . . . . .
.
.
.
E. SOCIAL SECURITY NUMBER
F. EMPLOYEE NAME (FIRST NAME)
(M.I.) (LAST NAME)
G. TOTAL SUBJECT WAGES
H. PIT WAGES
I. PIT WITHHELD
.
.
.
J. TOTAL SUBJECT WAGES THIS PAGE
K. TOTAL PIT WAGES THIS PAGE
L. TOTAL PIT WITHHELD THIS PAGE
0.00
0.00
0.00
.
.
.
M. GRAND TOTAL SUBJECT WAGES
N. GRAND TOTAL PIT WAGES
O. GRAND TOTAL PIT WITHHELD
.
.
.
P. I declare that the information herein is true and correct to the best of my knowledge and belief.
Preparer’s
Signature
Title
Phone (
)
Date
(Owner, Accountant, Preparer, etc.)
DE 6 Rev. 5 (1-08) (INTERNET)
MAIL TO: State of California / Employment Development Department / P.O. Box 826288 / Sacramento, CA 94230-6288
CU
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