Oklahoma Quarterly Contribution Report – Fill Out and Use This PDF

DO NOT STAPLE OR SUBMIT COPIES

WOES - 3 (REV 03-10)

Cartridge / Diskette Submitted

OKLAHOMA EMPLOYMENT SECURITY COMMISSION

1. Employee Social Security Number

2. Last Name

First Name

3. Total Wages Paid

4. Taxable Wages Paid

To obtain scannable "Continuation Sheets", visit website.

PAGE TOTAL

13. Monthly count of all full and part-time workers who worked

5.

TOTAL WAGES PAID (Item 3, All Pages)

or received pay subject to unemployment insurance for the

. . . . . . . . . . . . . . . . . . . . .

payroll period that includes the 12th of the month.

Month 3

6.

TAXABLE WAGES PAID (Item 4, All Pages)

Month 1

Month 2

. . . . . . . . . . . . . . . . . . . . .

7.

Contribution Rate for This Calendar Quarter

. . . . .Enter rate as a decimal, Ex. 0.3% = .003

. . . . . . . .8. Contributions Due (Taxable Wages #6 x Contributions Rate #7)

14. Oklahoma Account Number

16.

Qtr / Yr

9. Interest Due (1% per month after due date)

15. Federal I.D. No.

17.

Due Date

10. 10% Penalty Due $___________ + $100.00 Penalty Due =

11. Debit or Credit.

18.

Taxable Amount For

12. PAY THISAMOUNT

ENTER AMOUNTOF CHECK

W003

MAKE CHECK PAYABLE TO: Oklahoma Employment Security Commission

OFFICIALUSE ONLY

19.

Name / Address

I certify this report is correct and that no contribution is paid by any employee.

Signature ____________________________________________________

Date _________________ Contact Phone (

)

Contact Name ________________________________________________