Form 21e - Employer'S Annual Contribution, Investment Fee And Wage Report

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Form 21E (rev 3/08)
Page 1
Employer's Annual Contribution, Investment Fee and Wage Report
South Dakota Department of Labor, Unemployment Insurance Division
P.O. Box 4730 • Aberdeen, South Dakota 57402-4730 • Phone 605-626-2312 • Fax 605-626-3347 • Web site
Employer
Account Number
Address
Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Social Security
3/31
6/30
9/30
12/31
Employee Name
Number
Total Wages
Excess Wages
Total Wages
Excess Wages
Total Wages
Excess Wages
Total Wages
Excess Wages
Quarter Totals

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