CONTINUED The Taxable Wage Base for each employee is Grand Total Wages (All Pages) Wages in Excess Close account, last (See Instruction 9) payroll date: Subject Wages Contribution Rate (Enter Please Select Reason Out of Business 0.026 percentages in decimal form) New Owner Contribution Due Interest (1% per month) Change name, address, or phone: New Owner Late Penalty ($25.00min) Please Select Reason Current Owner Total Payment Due Please enter phone number if Name: (Make check payable to Utah Unemployment Compensation Fund] missing or incorrect. Address: Current Phone: Phone: Mark Wayland Owner 435-555-9677 Name Title Date Contact Phone Number Signature I certify the information on this report is true and correct to the best of my knowledge. AFFIAIAI FABLE ITEPI F RA LIFT LIEF