Form Nys-45 - Quarterly Combined Withholding, Wage Reporting, And Unemployment Insurance Return Page 2

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Withholding
identification number
41319420
Part D - Form NYS-1 corrections/additions
Use Part D only for corrections/additions for the quarter being reported in Part B of this return. To correct original withholding information
reported on Form(s) NYS-1, complete columns a, b, c, and d. To report additional withholding information not previously submitted on
Form(s) NYS-1, complete only columns c and d. Lines 12 through 15 on the front of this return must reflect these corrections/additions.
a
b
c
d
Original
Original
Correct
Correct
last payroll date reported
total withheld
last payroll date
total withheld
on Form NYS-1, line A (mmdd)
reported on Form NYS-1, line 4
(mmdd)
Part E - Change of business information
22. This line is not in use for this quarter.
23. If you permanently ceased paying wages, enter the date (mmddyy) of the final payroll
........
(see Note below)
24. If you sold or transferred all or part of your business:
• Mark an X to indicate whether in whole
or in part
• Enter the date of transfer (mmddyy) ................................................................................................................
• Complete the information below about the acquiring entity
Legal name
EIN
Address
Note: For questions about other changes to your withholding tax account, call the Tax Department at (518) 485-6654; for your unemployment
insurance account, call the Department of Labor at (518) 485-8589 or 1 888 899-8810. If you are using a paid preparer or a payroll service, the
section below must be completed.
Mark
Preparer’s signature
Date
Preparer’s NYTPRIN
Preparer’s SSN or PTIN
Paid
an X if
preparer’s
self-employed
use
Preparer’s firm name
(or yours, if self-employed)
Address
Firm’s EIN
Telephone number
(
)
Payroll service’s name
Payroll
service’s
EIN
Checklist for mailing:
Mail to:
• File original return and keep a copy for your records.
NYS EMPLOYMENT TAXES
• Complete lines 9 and 19 to ensure proper credit of payment.
PO BOX 4119
• Enter your withholding ID number on your remittance.
BINGHAMTON NY 13902-4119
• Make remittance payable to NYS Employment Taxes.
• Enter your telephone number in boxes below your signature.
• See Need help? on Form NYS-45-I if you need forms or assistance.
NYS-45 (1/13) (back)

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