Form De 2251a - Affidavit Of Mailing
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2AFFIDAVIT OF MAILING
Please read instructions on the following page prior to completing this form.
Account No.
Business Name
I,
, declare that on
(Print Name)
(Date Originally Mailed)
I mailed the following document(s):
DE 3BHW, Employer of Household Worker(s) Quarterly Report of Wages and Withholdings, for quarter
ending
.
DE 3D, Quarterly Contribution Return (Voluntary Plan), for quarter ending
.
DE 3HW, Employer of Household Worker(s) Annual Payroll Tax Return, for year ending
.
1
DE 6, Quarterly Wage and Withholding Report,
for quarter ending
.
1
DE 7, Annual Reconciliation Statement,
for the year
.
2
DE 9, Quarterly Contribution Return and Report of Wages,
for quarter ending
.
2
DE 9C, Quarterly Contribution Return and Report of Wages (Continuation),
for quarter ending
.
DE 88, Payroll Tax Deposit, for payroll date
.
PAYMENT TYPE:
Next-Day
Semiweekly
Monthly
Quarterly
Check No.
Date
Amount
Other
by placing them in the United States mailbox/post office located at:
.
The document(s) was/were contained in (a) sealed envelope(s) with postage fully prepaid and properly addressed
to the Employment Development Department (EDD).
I declare under penalty of perjury that the foregoing is true and correct.
Executed at
,
on
(City)
(State)
(Date)
(Signature and title of person who mailed the document[s].)
(Business Address)
(City)
(State)
(ZIP Code)
(Business Phone)
1
For calendar years ending December 31, 2010, and prior.
2
For calendar years beginning January 1, 2011, and after.
P.O. Box 826805 • Sacramento CA 94205-0001
DE 2251A Rev. 22 (2-13) (INTERNET)
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CU
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