Form De 9c - Quarterly Contribution Return And Report Of Wages (Continuation) - 2017
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1QUARTERLY CONTRIBUTION
QUARTERLY CONTRIBUTION
RETURN AND REPORT OF WAGES
RETURN AND REPORT OF WAGES
(CONTINUATION)
(CONTINUATION)
009C0111
REMINDER: File your DE 9 and DE 9C together.
REMINDER: File your DE 9 and DE 9C together.
Page number _______ of ______
Page number _______ of ______
You must FILE this report even if you had no payroll. If you had no payroll,
You must FILE this report even if you had no payroll. If you had no payroll,
YR
YR
QTR
QTR
complete Items C and O.
complete Items C and O.
DELINQUENT IF
DELINQUENT IF
QUARTER
QUARTER
NOT POSTMARKED
NOT POSTMARKED
ENDED
ENDED
DUE
DUE
OR RECEIVED BY
OR RECEIVED BY
EMPLOYER ACCOUNT NUMBER
EMPLOYER ACCOUNT NO.
DO NOT ALTER THIS AREA
DO NOT ALTER THIS AREA
P1
C
T
S
W
A
P1
C
T
S
W
A
EFFECTIVE DATE
EFFECTIVE DATE
Mo.
Day
Yr.
WIC
Mo.
Day
Yr.
WIC
A. EMPLOYEES full-time and part-time who worked during
A. EMPLOYEES full-time and part-time who worked during
or received pay subject to UI for the payroll period which
or received pay subject to UI for the payroll period which
includes the 12th of the month.
includes the 12th of the month.
1st Mo.
2nd Mo.
3rd Mo.
1st Mo.
2nd Mo.
3rd Mo.
Check this box if you are reporting ONLY Voluntary Plan Disability Insurance wages on this page.
Check this box if you are reporting ONLY Voluntary Plan Disability Insurance wages on this page.
C.
C.
NO PAYROLL
NO PAYROLL
B.
B.
Report Personal Income Tax (PIT) Wages and PIT Withheld, if appropriate. (See instructions for Item B.)
Report Personal Income Tax (PIT) Wages and PIT Withheld, if appropriate. (See instructions for Item B.)
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
.
.
.
.
.
.
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
F. TOTAL SUBJECT WAGES
F. TOTAL SUBJECT WAGES
G. PIT WAGES
G. PIT WAGES
H. PIT WITHHELD
H. PIT WITHHELD
.
.
.
.
.
.
(M.I.)
(LAST NAME)
(M.I.)
(LAST NAME)
D. SOCIAL SECURITY NUMBER
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
E. EMPLOYEE NAME (FIRST NAME)
F. TOTAL SUBJECT WAGES
F. TOTAL SUBJECT WAGES
G. PIT WAGES
G. PIT WAGES
H. PIT WITHHELD
H. PIT WITHHELD
.
.
.
.
.
.
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
.
.
.
.
.
.
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
.
.
.
.
.
.
D. SOCIAL SECURITY NUMBER
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
(M.I.)
(LAST NAME)
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
F. TOTAL SUBJECT WAGES
G. PIT WAGES
H. PIT WITHHELD
.
.
.
.
.
.
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
D. SOCIAL SECURITY NUMBER
E. EMPLOYEE NAME (FIRST NAME)
(M.I.)
(LAST NAME)
F. TOTAL SUBJECT WAGES
F. TOTAL SUBJECT WAGES
G. PIT WAGES
G. PIT WAGES
H. PIT WITHHELD
H. PIT WITHHELD
.
.
.
.
.
.
I. TOTAL SUBJECT WAGES THIS PAGE
I. TOTAL SUBJECT WAGES THIS PAGE
J. TOTAL PIT WAGES THIS PAGE
J. TOTAL PIT WAGES THIS PAGE
K. TOTAL PIT WITHHELD THIS PAGE
K. TOTAL PIT WITHHELD THIS PAGE
0.00
0.00
0.00
0.00
0.00
0.00
.
.
.
.
.
.
L. GRAND TOTAL SUBJECT WAGES
L. GRAND TOTAL SUBJECT WAGES
M. GRAND TOTAL PIT WAGES
M. GRAND TOTAL PIT WAGES
N. GRAND TOTAL PIT WITHHELD
N. GRAND TOTAL PIT WITHHELD
.
.
.
.
.
.
O. I declare that the information herein is true and correct to the best of my knowledge and belief.
O. I declare that the information herein is true and correct to the best of my knowledge and belief.
Required
Signature _____________________________ Title ___________________________ Phone (
Required
Signature _____________________________ Title ___________________________ Phone (
) _____________________ Date
) _____________________ Date
_________________________________
_________________________________
(Owner, Accountant, Preparer, etc.)
(Owner, Accountant, Preparer, etc.)
SIGN AND MAIL TO: State of California / Employment Development Department / PO Box 989071 / West Sacramento CA 95798-9071
MAIL TO: State of California / Employment Development Department / P.O. Box 989071 / West Sacramento CA 95798-9071
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