Form C-147 - Vermont Employer'S Quarterly Wage Report

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VERMONT EMPLOYER'S QUARTERLY WAGE REPORT
EMPLOYER NO.
QUARTER ENDING DATE EMPLOYER NAME
VT. DEPT. OF EMPLOYMENT & TRAINING l P.O. Box 488
l Montpelier, VT 05601-0488
l
Phone (802) 828-4000
INDIVIDUAL EMPLOYEE WAGE DATA FOR THIS QUARTER (Please type or print entries)
1. SOCIAL SECURITY
2. EMPLOYEE'S NAME
3. TOTAL GROSS WAGES
4. H/S 5. HOURLY
6. GENDER
RATE
M / F
NUMBER
(LAST, FIRST, MIDDLE INITIAL)
PAID THIS QUARTER
TOTAL WAGES
7. PAGE _________of _________
THIS PAGE
THIS REPORT PAGE MUST BE RETURNED
WITH A PROPERLY SIGNED AND DATED
QUARTERLY WAGE & CONTRIBUTION REPORT (Form C-101)
C-147 (9/01) WEB

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