Form Dws-Ark-209bs - Employer'S Quarterly Contribution And Wage Report Page 2
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2DWS-ARK-209CS (209 BSR Continued)
You must complete this report quarterly listing all employee’s names, social security num-
bers and total gross wages paid in the quarter. The tax payment due is to be remitted
with this report.
CONTINUATION SHEET FOR FORM 209BSR
DWS ID Number ___________________________________
Quarter End Date _____________________
Employer ____________________________________________________________
Town
_________________________________________
Page ________ of ________
WAGES PAID
WAGES PAID
IN SEASON
OUT OF SEASON
SOCIAL SECURITY NO.
FIRST NAME, INITIAL & LAST NAME OF EMPLOYEE
1 ]
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$
2 ]
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$
3 ]
$
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4 ]
$
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5 ]
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$
6 ]
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$
7 ]
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$
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$
11 ]
$
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12 ]
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$
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$
14 ]
$
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15 ]
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$
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$
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$
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$
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$
22 ]
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$
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$
24 ]
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$
25 ]
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$
$
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TOTAL
WAGES
FOR THIS PAGE
DWS-ARK-209CSR
(REV. 06-06)
52
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