Form Nys-45-Att - Quarterly Combined Withholding, Wage Reporting And Unemployment Insurance Return-Attachment Page 2

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NYS-45-ATT
Quarterly Combined Withholding, Wage Reporting
(9/98)
and Unemployment Insurance Return-Attachment
69919916
A. This return covers the period indicated below:
UI Employer Registration Number
Jan 1 -
Apr 1 -
July 1 -
Oct 1 -
Tax
Mar 31
Jun 30
Sep 30
Dec 31
Year
Withholding Identification Number
1
2
3
4
Y Y
Check applicable box(es):
Employer Legal Name
B. Other wages only reported on this page . . . . . . . .
C. If seasonal employer, check box . . . . . . . . . . . . . . . . .
Annual wage and withholding totals
If this return is for the 4th quarter or the last
Quarterly employee/payee wage reporting information
return you will be filing for the calendar year,
complete columns (d) and (e).
(d) Gross wages subject
(e) Total tax
(c) UI total remuneration / gross
(a) Social security no.
(b) Last name, first name, middle initial
to withholding
withheld
wages paid this quarter
Total this page only. . . . . . . .
Page No.
of
If first page, enter grand totals
of all pages . . . . . . . . . . . . . . . . . . . . .
If you are using a paid preparer or a payroll service, the section below must be completed:
Preparer’s signature
Telephone number
Date
Check if
Preparer’s social security number
□
Paid
self-employed
(
)
Preparer’s
Preparer’s firm name
Address
(or yours, if self-employed)
Preparer’s EIN
Use
Payroll
Payroll service name
Payroll service address
Service’s
EIN
For office use only
Mail to: NYS EMPLOYMENT TAXES
Postmark
Received date
CHURCH STREET STATION
PO BOX 1417
NEW YORK NY 10008-1417

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