Form Wvuc-A-154 - Contribution Report - West Virginia Unemployment Compensation Division
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1WVUC-A-154
Rev. 8-09
West Virginia Unemployment Compensation
CONTRIBUTION REPORT
See more instructions on separate sheet.
MUST BE TYPEWRITTEN OR PRINTED IN BLACK INK IN ALL CAPITAL LETTERS. DO NOT PRINT COMMAS, DECIMALS OR $ SIGNS.
1) EMPLOYER NAME & ADDRESS
2) EMPLOYER NUMBER
3) FOR CALENDAR QTR
5) DUE DATE
4) FEDERAL ID NUMBER
If your Federal ID No.
shown is incorrect enter
correct number here:
6) Total wages paid this quarter
including cents
-
16)
Number of employees in the pay period including the
,
,
.
(See instructions)
Do not make adjustments
12th of the month
for prior quarters.
7) Excess wages paid during quarter to each
,
,
.
employee. (See instructions)
1st Month =
8) Taxable wages: Subtract Line 7 from Line 6 -
,
,
.
2nd Month =
9) Your tax rate for this quarter =
3rd Month =
10) Contributions for this quarter = Multiply Line
Total number of employees
,
,
.
8 by Line 9
on your wage report
11) Penalty due if this report is filed and paid after
17) Signature date
Due Date = 0.10 x Line 10 but not less than
,
,
.
$50 or more than $500
Interest due if this report is filed after Due
12)
Date = Multiply Line 10 + Line
,
,
.
18) Title of individual signing
11 x No. of days late x 0.00033
13) Less credit from previous overpayment.
,
,
.
Attach copy of credit memorandum, Form
WVUC A94-B
19) Preparer’s telephone number
14) Enter the Exact Amount of Payment
,
,
.
Submitted with this Report.
Make Checks Payable To:
Unemployment Compensation Division
20) Signature below certifies that the information contained
herein is true and correct to the best of the signer’s
knowledge.
Prior balance due on your account as of:
15)
(See Instructions)
.
PHOTOCOPY BOTH THE CONTRIBUTION AND WAGE REPORTS FOR YOUR RECORDS, MAIL THE ORIGINALS (NO PHOTOCOPIES)
AND YOUR CHECK TO:
UNEMPLOYMENT COMPENSATION DIVISION
WORKFORCE West Virginia
OFFICE USE ONLY
CONTRIBUTION ACCOUNTING
NC NW NP
NI
CP AD EW
PO BOX 106
CHARLESTON, WV 25321-0106
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