Form K-Cns 1001 - Quarterly Wage Report & Unemployment Tax Return - 2010
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1QUARTERLY
K
D
H
R
ANSAS
EPARTMENT OF
UMAN
ESOURCES
WAGE REPORT &
UNEMPLOYMENT TAX RETURN
1. Employer's Name and Address
2. Account
Number
____ ____ ____ ____ ____ ____
3. Quarter Ending
Quarter
Q
YYYY
MM/DD/YYYY
Year
4. To avoid a penalty this return must be postmarked by
the last day of the month after the quarter ending date.
5. Number of continuation sheets attached
This report MUST BE FILED if you have an active account, even IF you have NO WAGES or NO TAX due.
8. Total Wages
9. Excess Wages
6. Social Security Number
7. Employee Name
Paid This Quarter
See instructions
000
00
0000
Last, First, Middle Initial
Dollars
Cents
Dollars
Cents
Total Wages for THIS page
10.
11.
For each month, report the number of
12. Total Wages from ALL pages
covered workers who worked during or
If NO WAGES were paid, enter ZEROS here and in items 13 & 14. Sign & Return.
received pay for the payroll period
which includes the 12th of the month.
13. Total Excess Wages from ALL Pages
1st Month
2nd Month
3rd Month
14. Compute Taxable Wages
Total Wages (item 12) minus Excess Wages (item 13)
15. Unemployment Tax Due
Multiply Taxable Wages (item 14) by your Tax Rate
16. Prior Overpayment
SUBTRACT
Attach K-CNS 111 Adjustment OR K-CNS 2101 Credit Memo
17. Maximum $200 late filing penalty
ADD
Minimum $25 penalty. See instructions
FOR KDHR USE
18. Interest on late payment
ADD
DEPOSIT ________________
CODE
1% for each part or whole month
CONTRI ________________
11
19. Prior amount due
ADD
PENALTY ________________
INTEREST ________________
20. Total Due. If tax is $1 or more, pay to KANSAS EMPLOYMENT SECURITY FUND
PENALTY ________________
CODE
send to PO Box 400, Topeka, KS 66601-0400
INTEREST ________________
31
21. I certify that the information on this return is true, correct and complete, to the best of my knowledge and belief.
Name &
Area Code &
Signature____________________________________________________________
Phone Number___________________
Date_____________
K-CNS 1001 (Rev. 10-00)
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