Form W-118a - Employer'S Wage Attachment Remittance
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Employer’s Wage Attachment Remittance
Please reproduce this form and mail with future payments.
Employer’s name
Instructions. Complete and send with your payment to the address below.
Use one line for each employee from whom you have withheld delinquent taxes.
Do not include regular amounts of income taxes withhold.
Payroll phone number
(
)
-
Make checks payable to:
Wisconsin Department of Revenue
Contact person name
Mail remittance with this form to:
Wisconsin Department of Revenue
Central Collection Section
If payroll address has changed, enter new address below.
PO Box 8960
Address
Madison WI 53708-8960
City
State
Zip
TERMINATED EMPLOYEE: You are required to withhold the entire amount
payable to terminated employees or an amount equal to the balance of certification.
Entry required if it applies to an employee under a wage certification.
Check ONLY
Entry Required for Each Employee that had Delinquent Amounts Withheld This Period
Check whichever applies and enter the requested dates.
if this is
the FINAL
Payment of
Anticipated
Name of Employee
Employee’s Social
Delinquent Amount
the Wage
Last Day of Work
Return Date
Security Number
Withheld
Attachment
(month - year)
TOTAL AMOUNT WITHHELD
$
W-118a (R. 2-16)
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