Form Vec-Fc-21 - Employer'S Quarterly Payroll Report

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Virginia Employment Commission
EMPLOYER'S QUARTERLY PAYROLL REPORT
P.O. Box 27483
Richmond, Virginia 23261-7483
VIRGINIA ACCOUNT NO.
EMPLOYER NAME
CALENDAR QTR. ENDING
1. EMPLOYEE SOCIAL SECURITY NO.
2. EMPLOYEE NAME (FIRST, INITIAL, LAST)
3. TOTAL WAGES PAID IN QUARTER
DOLLARS
CENTS
PAYROLL REPORT - RETURN TO COMMISSION
4. TOTAL WAGES
INSTRUCTIONS ON REVERSE OF EMPLOYER COPY
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
VEC-FC-21 (4/97)

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