Form Ncui 101 - Employerr'S Quarterly Tax And Wage Report Page 2

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CONTINUATION SHEET FOR
EMPLOYMENT SECURITY COMMISSION
OF NORTH CAROLINA
REPORT OF EMPLOYEES WAGES
P. 0. BOX 26504
RALEIGH, NC 27611-6504
ACCOUNT NUMBER
PAGE NO.
EMPLOYER NAME
EMPLOYEE NAME
SOCIAL SECURITY
WAGES PAID
LAST NAME
NUMBER
INITIAL
INITIAL
THIS QUARTER
SEASONAL
QUARTER-YEAR
TYPE EMPLOYER
NAME, ACCOUNT
NUMBER, AND QUARTER-
YEAR AS SHOWN ON
FORM NCUI 101.
RETURN
THIS PAGE IF
NEEDED TO
COMPLETE REPORT
PAGE TOTAL
NCUI 101-B

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