New Jersey Economic Development Authority Certified Weekly Payroll Report

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EDA PW Form 4
NEW JERSEY ECONOMIC DEVELOPMENT AUTHORITY
CERTIFIED WEEKLY PAYROLL REPORT (REVISED 01/2014)
The information below must be submitted to the NJEDA pursuant to N.J.A.C. 19:30-3.5-9 and N.J.A.C. 19:30-4.4
NJEDA
SEND COMPLETED FORMS TO:
24 Commerce Street - Suite 301 - Internal Process Management
Newark, NJ 07102 / Office # 973-855-3447 /
CONTRACTOR INFORMATION
PROJECT INFORMATION
NAME:
NJEDA PROJECT NUMBER:
ADDRESS:
PROJECT NAME:
CITY:
ST
ZIP
MUNICIPALITY:
PHONE:
COUNTY:
EMAIL:
PAYROLL PERIOD ENDING DATE:
/
/
mm
dd
year
Employee Name
Total
PLEASE SPECIFY DAY AND DATE
Gross
Total
Fringe
Rate of
Address
With-
Total
Trade
Weekly
FICA
Net Pay
Pay
holding Tax
Deductions
Hours
Benefit
City, State, Zip
Pay
Cost/Hr.
HOURS WORKED EACH DAY
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
ST
OT
O
EDA Form PW-4 (page 1)

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