Form Nucs-4073 - Employer'S Quarterly List Of Wages Paid Continuation Sheet
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1STATE OF NEVADA
DEPARTMENT OF EMPLOYMENT, TRAINING AND REHABILITATION
EMPLOYEMNT SECURITY DIVISION
500 E. Third Street
DIVISION USE ONLY
Carson City, Nevada 89713-0030
EMPLOYER'S QUARTERLY LIST OF WAGES PAID
SIC
AREA
CONTINUATION SHEET
Date Quarter Ended
Page No.
Acct. No
This form must be accompanied by the form
"Employer's Quarterly Contributions
and Wage Report"
Enter in this space Employer's Account No., Name and Address
Employee's Social Security
Total Tips Declared
Total Wages (Including
Name of Employee
Account No.
This Quarter
Declared Tips) This Quarter
Total Wages and Tips This Page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
NUCS-4073 (Rev. 11-97)
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Parent category: Financial