Form Wyo 065 - Payment Coupon
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1Payment Coupon
WYO 065
04 / 24 / 03
*0650403*
●
Business Name
Check #
Quarter/Year
UI Account #
WC Employer #
UI Amount
UI Amount
Due $
Paid $
WC Amount
WC Amount
Due $
Paid $
-
-
Total Amount
Check Amount $
Due $
State Use Only
Date Received
Payment Type
Initials
Postmark
Date
●
Return to:
Wyoming Department of Employment
Employment Tax Division
P O Box 20006
Cheyenne WY 82003
FISCAL
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Parent category: Financial