Form Nys-45-X - Amended Quarterly Combined Withholding, Wage Reporting, And Unemployment Insurance Return

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Amended Quarterly Combined Withholding,

NYS-45-X

Wage Reporting, and Unemployment Insurance Return

(12/13)

If seasonal employer, mark an X in the box:

UI Employer registration number

This return should be completed to amend a

previously filed return. A separate return must be

Withholding identification number

completed for each quarter to be amended. Mark only

one box to indicate the quarter and enter the year.

Employer legal name:

Apr 1 -

Jan 1 -

July 1 -

Oct 1 -

Jun 30

Mar 31

Sep 30

Dec 31

Year

Y Y

Part A - Unemployment insurance (UI) information

Correct amounts

Difference

Previously reported amounts

1. Total remuneration paid

0 0

this quarter ......................

2. Remuneration paid this quarter

in excess of the UI wage base

0 0

since January 1

.......

(see instr.)

Wages subject to contribution

0 0

.....

(subtract line 2 from line 1)

4. Enter your

total UI rate

(see instructions)

5. UI contributions due

........ 5a

(multiply line 3 x line 4)

6. Overpayment to be applied to outstanding liabilities and/or refunded

.............................................

(if line 5a is greater than 5b, enter the difference here)

7. Additional unemployment insurance amount due

.....................................................................................................................

(if line 5a is less than 5b, enter the difference here)

Part B - Withholding tax (WT) information

Correct amounts (an amount equal to or

greater than zero must be entered on each line)

Previously reported amounts

8. New York State

tax withheld ........................

9. New York City

tax withheld ........................

10. Yonkers

tax withheld ........................

11. Total tax withheld

...........

(add lines 8, 9, and 10)

Complete Parts C and D on

12. If you marked line 20b on your previous quarter’s Form NYS-45, enter the

back of this form, if required.

amount from line 20 of that form ...................................................................

13. Form NYS-1 payments made for the quarter you are amending .................

14. WT payments made with previously filed Forms NYS-45 (line 19) and/or

Form NYS-45-X (line 19) for the quarter you are amending .........................

15. Total payments

........................................

(add amounts on lines 12, 13, and 14)

16. Overpayment, if any, shown on previously filed Forms NYS-45 (line 20)

51339418

and/or Form NYS-45-X (line 18) ...................................................................

17. Subtract line 16 from line 15 .........................................................................

18. Overpayment to be applied to outstanding liabilities and/or refunded

(if line 17 is greater than line 11, enter the difference here) ............................................

19. Additional withholding tax amount due

.......................................................................................................................

(if line 17 is less than line 11, enter the difference here)

20. Additional payment due (add lines 7 and 19 ; make one remittance payable to NYS Employment Contributions and Taxes).

An overpayment of either UI contributions or withholding tax cannot be used to offset an amount due for the other ....................

Sign your return:

I certify that the information on this return is to the best of my knowledge and belief true, correct, and complete. If you are using a paid preparer or a payroll service, complete the section on the back.

Signature

Signer’s name

Title

(see instructions)

(please print)

Telephone number

Date

For office

(

)

use only

Postmark