Form Dol-4a - Annual Tax And Wage Report For Domestic Employment

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ANNUAL TAX AND WAGE REPORT FOR DOMESTIC EMPLOYMENT -
* 4 8 9 9 9 *
PART I
*48999*
GEORGIA DEPARTMENT OF LABOR - P.O. BOX 740234 - ATLANTA, GA 30374-0234
Tel. (404) 232-3245
DOL Account Number
Year
Parts I & II of this report must
be submitted together.
1. Social Security Number
2. Employee's Name (If blank, please enter.)
3. Total Individual
For Quarter Ending
Reportable Gross Wages
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
September 30
$
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
September 30
$
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
$
December 31
$
March 31
Social Security Number
Full Last Name, Full First Name
$
June 30
$
September 30
December 31
$
$
March 31
Full Last Name, Full First Name
Social Security Number
$
June 30
$
September 30
$
December 31
TOTAL REPORTABLE GROSS
PAGE
OF
WAGE SHEETS
WAGES PAID THIS YEAR
$
MESSAGE AREA
DOL-4A (7/14)
EL6101

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