Form 3h - Employer'S Quarterly Wage List - Utah Department Of Workforce Services

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DWS-UI
READ REVERSE BEFORE
Form 3H
Utah Department of Workforce Services
COMPLETING THIS REPORT
Rev. 7/98
Unemployment Insurance
EMPLOYER’S QUARTERLY WAGE LIST
Blank Issued To:
Blank Issued To:
(999)999-9998
EMPLOYERS UTAH
EMPLOYER NAME:
REGISTRATION NUMBER
ADDRESS:
QUARTER ENDING DATE
ENTER GRAND TOTALS ON PAGE 1 ONLY
Total Wages from line 3
NOTE: These two
Total Wages reported on
of Contribution Report
Totals should agree
Wage Lists (all pages)
PLEASE TYPE ALL INFORMATION - DOUBLE SPACE ONLY
SOCIAL SECURITY
EMPLOYEE NAME
TOTAL WAGES PAID EACH
HIRE DATE IF IN THIS
ACCOUNT NUMBER
EMPLOYEE IN THIS QUARTER
QUARTER (MM-DD-YY)
First Initial
Middle Initial
Last Name
TOTAL OF THIS PAGE ONLY
Please do not submit photocopies of wage list forms.
Read reverse side for how to obtain additional forms.
Page No.

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