Form Es903a - Employer'S Quarterly Wage And Contribution Report - 2005
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1
2EMPLOYER'S QUARTERLY WAGE
AND CONTRIBUTION REPORT
ES903A
DO NOT WRITE IN THIS SPACE
DATE RECEIVED
SCHEDULE A
NEW MEXICO DEPARTMENT OF LABOR, P O BOX 2281, ALBUQUERQUE, NM 87103-2281*PHONE (505) 841-2000
RETURN THIS REPORT AND TAX DUE BY THE END OF THE MONTH FOLLOWING THE CLOSE OF THE CALENDAR QUARTER, IF NO WAGES, SHOW "NONE"
EMPLOYER'S NUMBER
TAX RATE
QUARTER ENDING
DUE DATE
FEDERAL IRS NUMBER
FIELD CODE
1. TOTAL WAGES (TOTAL COLUMN 12).....................................................................
$
2. DEDUCT EXCESS WAGES (TOTAL COLUMN 13)..................................................
$
3. TAXABLE WAGES (ITEM I LESS ITEM 2).........................................................................
$
4. TAX DUE (TAXABLE WAGES X RATE).........................................................................
$
DO NOT WRITE HERE
TAXABLE AMOUNT
BATCH
DATE
5. INTEREST DUE (1% PER MONTH AFTER DUE
THE TAXABLE BASE AMOUNT
DATE).........................................................................................................................................
$
(BASE WAGES) FOR
2001
IS $15,200
6. LATE REPORT PENALTY (ADD $50.00)................................................................................................
2002
IS $15,900
$
2003 IS
$16,600
7. LATE PAYMENT PENALTY (ADD 5% OF TAX
2004 IS
$16,800
DUE OR $25.00, WHICHEVER IS GREATER).............................................................................
2005 IS
$17,200
$
8. AMOUNT OF REMITTANCE.................................................................................................
$
"FOR EACH MONTH, REPORT THE NUMBER OF COVERED
WORKERS WHO WORKED DURING OR RECEIVED PAY FOR THE
9. INDICATE IF WAGES ON
MAGNETIC MEDIA
PAYROLL PERIOD WHICH INCLUDED THE 12TH OF THE MONTH"
ORIGINAL
9A 1ST MONTH
2ND MONTH 3RD MONTH
RETURN THIS COPY
SCHEDULE B
10. EMPLOYEE SOCIAL
12. GROSS WAGES FOR
13. THIS QUARTER'S
SECURITY NUMBER
11. NAME OF EMPLOYEE
THIS QUARTER
EXCESS WAGES
TOTAL NUMBER OF PAGES IN THIS REPORT
TOTAL THIS PAGE
COMPLETE THIS PORTION ONLY IF THERE ARE CHANGES TO YOUR ACCOUNT
_____Final Report (Operating without employees or Business Discontinued) As Of (date):_________ ______________
_____Business Sold to: New Owner’s Name:___________________________________________________________________________
Address, City, St, Zip: _____________________________________________________________
_____Change FEIN to #__________________________________Reason for Change:__________________________________________
_____Change Mailing Address to:____________________________________________________________________________________
_____Change Business Address to:___________________________________________________________________________________
_____Change Phone # to:________________________
Fax #________________________ Email Address:____________________
For Legal Name Changes, please provide DOL copy of Articles of Amendment & Completed ES-802, Status Report.
INCOMPLETE AND/OR UNSIGNED REPORTS ARE SUBJECT TO BEING RETURNED AND LATE REPORT PENALTIES BEING ASSESSED.
I certify that this report is true and correct according to law and department regulations, and that no part of the contribution was deducted from any employee's wages.
DATE________________________________ SIGNED
TITLE
REV. 03/05
001-0949
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