100%(1)1 out of 1 people found this document helpful
This preview shows page 17 - 20 out of 28 pages.
FILED6.TOTAL CONTRI-58 80 58.8XPAPER UC-2AMAGNETIC MEDIA UC-2ABUTIONS DUE(ITEMS 3 + 5)EMPLOYER'S2.8%CONTRIBUTIONEMPLOYER'SCHECK7.INTEREST DUERATEACCT. NO.DIGITSEE INSTRUCTIONS0059618.PENALTY DUESEE INSTRUCTIONS9.TOTAL REMITTANCE58 80 (ITEMS 6 + 7 + 8)LEMONICA COMPANYMAKE CHECKS PAYABLE TO: PA UC FUND123 SWAMP ROADPIKESVILLE, D STATE 1077-2017DATE PAYMENT RECEIVEDSUBJECTIVITY REPORTREPORT DELINQUENT DATE1stMONTH2ndMONTH3rdMONTHTOTAL COVERED EMPLOYEES IN PAY PERIOD INCL. 12th OF MONTHSignature certifies that the information contained herein is true and correct to the best of the signer’s knowledgeEMPLOYEE CONTRIBUTIONS
Employer nameEmployer PA UCCheckQuarter and yearQuarter ended date(Make corrections on Form UC-2B)account no.digitLEMONICA COMPANY0059614/201712/31/20171.Name and telephone number2.Total number of pages in this3.Total Number of employees4.Plant number (if approved)of preparerreportlisted in item 8 on all pages ofForm C-2ABERTRAM A. GOMBERS(613) 555-00295.Gross wages, MUST agree with item 2 on UC-26.Fill in this area of you would like the Department to preprint yourand the sum of item 11 on all pages of Form UC-2Aemployees’ names & SSNs on Form UC-2A next quarter X98100.007.Employee's social security number8. Employee's name9.Gross wages paidMILAST NAMEthis qtr. (Example:CreditFIRST NAME123456.00)Week000000001RobertG. Cramer52000013000000003DanielM.Enigish134000013000001998RuthA.Small24000013000007413HarryB.Klaus117000013000006523KennethN.George150000013000001014BertramA.Gompers263000013000007277ArthurS.Rooks1700008000008111MaryR.Bastiian82000013000002623KlausC.Werner25000013000003534KathyT.Tyler11700009LIST ANY ADDITIONAL EMPLOYEES ON CONTINUATION SHEETS IN THE REQUIRED FORMAT (SEE INSTRUCTIONS)98100 0011.Total gross wages for this page:12.Page 1 of 131-Jan-18$ 58.80 Report must be filed byAmount due with reportSee 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:
5–17A. out of 6 possibleForm940 for 20--:Employer’s Annual Federal Unemployment (FUTA) Tax ReturnDepartment of the Treasury — Internal Revenue ServiceEmployer identification number00-0006421Name (not your trade name)BERTRAM A. GOMPERSTrade name (if any)LEMONICA COMPANYAddress123 SWAMP ROADPIKEVILLED10777-2017Read the separate instructions before you fill out this form. Please type or print within the boxes.Part 1: Tell us about your return. If any line does NOT apply, leave it blank.1If you were required to pay your state unemployment tax in …1aD- OR -12If you paid wages in a state that is subject to CREDIT REDUCTION . . . . . . . . .2Part 2: Determine your FUTA tax before adjustments for 20--. If any line does NOT apply, leave it blank344▪Check all that apply:4a4c4e4b4d5 Total of payments made to each employee in excess of $7,000 . . . .