Form Nys-45-Att - Quarterly Combined Withholding, Wage Reporting, And Unemployment Insurance Return-Attachment

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NYS-45-ATT
Quarterly Combined Withholding, Wage Reporting,
(2/13)
And Unemployment Insurance Return - Attachment
61329416
Mark an X in the applicable box(es):
Withholding identification number:
A. Original
or
Amended return
Jan 1 -
Apr 1 -
July 1 -
Oct 1 -
Employer legal name:
Mar 31
Jun 30
Sep 30
Dec 31
Year
1
2
3
4
Y Y
B. Other wages only reported on this page .....
C. Seasonal employer ...................................
Annual wage and withholding totals
Quarterly employee/payee wage reporting information
If this return is for the 4th quarter or the last
return you will be filing for the calendar year,
(Do not enter negative numbers in columns c, d, and e; see instructions)
complete columns d and e.
Total NYS, NYC, and
b Last name, first name, middle initial
Total UI remuneration
Gross federal wages or
a
Social security number
c
d
e
paid this quarter
distribution (see instr.)
Yonkers tax withheld
Total this page only ......
Page No.
of
If first page, enter grand totals
of all pages .................................
Contact information Name
Daytime telephone number
(
)
(see instructions)
  For office use only
Mail to: NYS EMPLOYMENT CONTRIBUTIONS AND TAXES
Postmark
Received date
PO BOX 4119
BINGHAMTON NY 13902-4119

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