Form Es903a - Employer'S Quarterly Wage And Contribution Report - 2005 Page 2
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2New Mexico Department of Labor
SCHEDULE B - EMPLOYER'S REPORT OF WAGES PAID TO EACH EMPLOYEE
CONTINUATION SHEET
EMPLOYER'S NAME
EMPLOYER'S NUMBER
DBA
QUARTER ENDING
ADDRESS
10. EMPLOYEE SOCIAL
11. NAME OF EMPLOYEE
12. GROSS WAGES PAID
13. THIS QUARTER'S
SECURITY NUMBER
LAST, FIRST, MI
THIS QUARTER
EXCESS WAGES
TOTAL FOR THIS PAGE
PAGE #
ES-903B
Rev 1/97
001-0951
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