Form 21 - Annual Taxable Wage Base Per Employee - South Dakota Page 2

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Form 21A
(rev. 7/16)
UNEMPLOYMENT INSURANCE DIVISION
Employer's Report of Wages Paid to Each Employee
Continuation Sheet
/
Account Number
Quarter/Year
15. Employee's Social Security Number
16. Employee's Name (Last, First)
17. Total Gross Wages Paid This Quarter
18. Excess Wages This Quarter
19. Total Gross Wages This Page
20. Total Excess Wages This Page
21. Total Gross Wages All Pages
22. Total Excess Wages All Pages

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