Form 21d - Employer'S Annual Contribution, Investment Fee And Wage Report - 2007
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1Form 21D (rev. 3/07)
2007 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
Employer Name
Account Number
Address
2007
Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Computation of Payment Due
Totals
3/31/
2007
6/30/
2007
9/30/
2007
12/31/
2007
1. Total gross wages paid in this quarter
2. Wages in excess of $8,500 this quarter
3. Taxable Wages
4. UI Contribution Rate
% x line 3
5. Investment Fee
% x line 3
6. Total Tax Due
7. Adjustments from prior quarter(s)
8. Interest
%
%
%
%
9. Penalty for Late Filing
10. Penalty for Late Payment
11. Total Remittance
1. Total Gross Wages Paid. Enter here the total of all gross wages paid within this quarter.
Explanation:
2. Wages in excess of $8,500 this quarter. Enter here the total wages paid this quarter that are in
excess of an annual $8,500 per employee.
3. Taxable Wages. Subtract line 2 from line 1 and enter the total here.
4. UI Contribution Rate. Multiply wages from line 3 by the rate listed. Enter this amount here.
5. Investment Fee. Multiply wages from line 3 by the rate listed. Enter this amount here.
6. Total Tax Due. Add lines 4 and 5 and enter the amount here.
7. Adjustments from Prior Quarter. Enter any amounts due or refunds due to you from a prior
quarter.
8. Interest. Enter the interest due if report is late for the corresponding calendar quarter. The
interest amount is computed by multiplying the payment due on line 6 by 1.5% per month or
fractional part of a month for each month of delinquency.
Signature
9. Penalty for Late Filing. This penalty is imposed if the employer is late in filing a report. The
penalty is $5 per month or fractional part of a month from the due date of a report. Maximum
penalty is $30 per quarter.
Date
Phone
10. Penalty for Late Payment. This penalty is imposed if the employer is late in making full
payment. This penalty is $5 per month or fractional part of a month. Maximum penalty is $30 per
quarter.
11. Total Remittance. Enter the sum of lines 6,7,8,9, and 10.
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