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The information listed below refers to the employees of Lemonica Company for the year ended December 3 1 , 2 0 - - . The
The information listed below refers to the employees of Lemonica Company for the year ended December The wages are separated into the quarters in which they were paid to the individual employees.NameSocial Security #st Qtrnd Qtrrd Qtrth QtrTotalRobert G Cramer$$$$$Daniel M English ForemanRuth A SmallHarry B KlausKenneth N George ManagerMavis R JonesMarshall T McCoyBertram A Gompers PresidentArthur S RooksMary R BastianKlaus C WernerKathy T TylerTotals$$$$$For State Ds contribution rate for Lemonica Company, based on the experiencerating system of the state, was of the first $ of each employee's earnings. The state tax returns are due one month after the end of each calendar quarter. During the company paid $ of contributions to State Ds unemployment fund. The president of the company prepares and signs all tax forms. The company uses Magnetic Media UCA when completing the form.Employer's phone number: Employer's State D reporting number: Using the forms below, complete the following for Indicate on each form the date that the form should be electronically submitted and the amount of money that must be paid.a What is the date and amount of the FUTA tax payment for the fourth quarter of State D is not a credit reduction state. Enter date in mmddyyyy format.Tax Payment:Date Amount$fill in the blank b Employer's Report for Unemployment Compensation, State Dth quarter only. Item is the number of employees employed in the pay period that includes the th of each month in the quarter. For Lemonica Company, the number of employees is eight in October, seven in November, and eight in December. All employees earned credit weeks during the last quarter except for Rooks and Tyler If an input box does not require an entry, leave it blank. State D Form UC REV Employer's Report for Unemployment CompensationQTR.YEAR Read InstructionsAnswer Each ItemDUE DATEST MONTHND MONTHRD MONTHW EXAMINED BY: TOTAL COVERED EMPLOYEES IN PAY PERIOD INCL. TH OF MONTHfill in the blank fill in the blank fill in the blank Signature certifies that the information contained herein is true and correct to the best of the signer's knowledge. FOR DEPT. USEGROSS WAGES fill in the blank SIGN HEREDO NOT PRINTEMPLOYEE CONTRIBUTIONSX X X X X X X X XXXXXXXTITLEDATEPHONE #TAXABLE WAGES FOR EMPLOYER CONTRIBUTIONS fill in the blank FILED PAPER UCA INTERNET UCA FEDERAL IDENTIFICATION NUMBER EMPLOYER CONTRIBUTIONS DUE RATE X ITEM fill in the blank EMPLOYER'S ACCT. NO CHECK DIGITEMPLOYER'S CONTRIBUTION RATETOTAL CONTRIBUTIONS DUE ITEMS fill in the blank LEMONICA COMPANY SWAMP ROADPIKESVILLE, D STATEINTEREST DUESEE INSTRUCTIONS fill in the blank PENALTY DUESEE INSTRUCTIONS fill in the blank TOTAL REMITTANCE ITEMS $fill in the blank MAKE CHECKS PAYABLE TO: PA UC FUND SUBJECTIVITY DATE REPORT DELINQUENT DATE State D Form UCA Employer's QuarterlyReport of Wages Paid to Each EmployeeSee instructions on separate sheet. Information MUST be typewritten or printed in BLACK ink. Do NOT use commas or dollar signs $ If typed, disregard vertical bars and type a consecutive string of characters. If hand printed, print in CAPS and within the boxes as below:SAMPLE Typed:SAMPLE Handwritten:SAMPLE Filledin:Employer nameMake corrections on Form UCBEmployerState D UC account noCheckdigitQuarter and yearQYYYYQuarter ending dateMMDDYYYYLemonica Company Name and telephone number of preparer Total number of pagesin this report Total number of employees listed in item on all pages of Form UCA Plant numberif approvedfill in the blank fill in the blank Gross wages, MUST agree with item on UC and the sum of item on all pages of Form UCAfill in the blank Fill in this circle if you would like the Department to preprint your employee's names & SSNs on Form UCA next quarterYesEmployee's Employee's name Gross wages paid this qtr CreditSocial Security Number Omit HyphensFIMILASTExample: weeksSelect:RGCramerfill in the blank fill in the blank DMEnglishfill in the blank fill in the blank RASmallfill in the blank fill in the blank HBKlausfill in the blank fill in the blank KNGeorgefill in the blank fill in the blank BAGompersfill in the blank fill in the blank ASRooksfill in the blank fill in the blank MRBastianfill in the blank fill in the blank KCWernerfill in the blank fill in the blank KTTylerfill in the blank fill in the blank List any additional employees on continuation sheets in the required format see instructions Total gross wages for this page: Total number of employees for this page fill in the blank UCA REV Page of c Employer's Annual Federal Unemployment FUTA Tax ReturnForm Form for :Employer's Annual Federal Unemployment FUTA Tax ReturnDepartment of the Treasury Internal Revenue ServiceOMB NoEmployer identification number EINName not your trade nameLEMONICA COMPANYTrade name if any Address SWAMP ROAD NumberStreetSuite or room number PIKESVILLED CityStateZIP code Foreign country name Foreign provincecountyForeign postal code Type of ReturnSelect one.Go to wwwirs.govForm for instructions and the latest information.Read the separate instructions before you fill out this form. Please type or print within the boxes.Part : Tell us about your return. If any line does NOT apply, leave it blank. See instructions before completing Part aIf you had to pay state unemployment tax in one state only, enter the state abbreviation a DbIf you had to pay state unemployment tax in more than one state, you are a multistate employer b Check here.Complete Schedule A Form If you paid wages in a state that is subject to CREDIT REDUCTION Check here.Complete Schedule A Form Part : Determine your FUTA tax before adjustments. If any line does NOT apply, leave it blank. Total payments to all employees fill in the blank Payments exempt from FUTA tax
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