Form Dol-4n - Employer'S Quarterly Tax And Wage Report - Part I - Georgia Department Of Labor
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2EMPLOYER'S QUARTERLY TAX AND WAGE REPORT - PART I
GEORGIA DEPARTMENT OF LABOR<- P.O. BOX 740234 - ATLANTA, GA 30374-0234
Tel. (404) 656-3145
REPORT FOR THE QUARTER ENDING
Attach any wage sheets
to this page.
Use BLACK ink only.
DOL Account Number
Qtr/Yr
Total Tax Rate
Form must be Filed By
Parts I & II of this report must
always be submitted. Enter zeroes
in
if no
TOTAL GROSS WAGES PAID THIS QUARTER
wages were paid for this quarter.
1. Social Security Number
2. Employee's Name
3. Total Individual Wages
Paid This Quarter
Last
First
MI
,
.
$
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$
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$
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$
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$
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$
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$
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$
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$
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$
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$
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$
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$
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$
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TOTAL WAGES
PAGE
OF
WAGE SHEETS
,
.
$
,
FOR THIS PAGE
TOTAL GROSS WAGES
,
,
.
$
(Enter this amount on PART II, Line 2)
PAID THIS QUARTER
MESSAGE AREA
DOL-4N (R-9/97)
EL3103
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