South Dakota is a beautiful state located in the heart of the Midwest, and to many it offers an ideal balance of modern convenience and untouched nature. From bustling city streets to majestic national parks, South Dakota provides something for everyone: whether you're looking for a special getaway or just coming in for a day trip. Here at 21C Form, we recently had an opportunity to take an all-encompassing tour of this great state—so if you've been wanting to explore all that South Dakota has to offer, read on!
| Question | Answer |
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| Form Name | South Dakota From 21C Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | form 21c drug license, form 21 drug license download, drug licence online verification, form 21c for drug licence |
Form 21C (rev. 4/12)
Statement to Correct Information Previously Submitted
South Dakota Department of Labor and Regulation, Unemployment Insurance Division
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PO Box 4730 • Aberdeen, SD |
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Account Number |
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UI Rate |
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Employer |
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IF Rate |
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A separate report is required for each year. |
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Surcharge Rate |
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Q2 Q3 |
Q4 |
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____% |
_____% ____% ____% |
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Amount Reported on Original Report |
Correct Amount |
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Qtr/Yr to |
Total Wages |
Wages Paid in |
Total Wages |
Wages Paid in |
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Social Security # |
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Employee Name |
be Corrected |
Paid This Quarter |
Excess of $________ |
Paid This Quarter |
Excess of $________ |
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Explanation: |
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Annual taxable wage base: |
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2009 = $9,500 |
2013 = $13,000 |
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2010 = $10,000 |
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2014 = $14,000 |
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2011 = $11,000 |
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2015 & later = $15,000 |
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2012 = $12,000 |
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office |
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Make a copy of |
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coding |
3/31/____ |
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6/30/____ |
9/30/____ |
12/31/____ |
Total |
this report for your |
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Net Change in Total Wages |
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records. Send |
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original to the |
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Net Change in Excess Wages |
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Unemployment |
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Net Change in Taxable Wages |
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Insurance Division |
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Additional Contribution Due |
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of South Dakota. |
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Reduction in Contribution |
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Adjustments |
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Interest (1.5% per month from due date) |
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Penalty |
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Total Payment/Refund |
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I certify all information on this report is complete and correct. |
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Signature |
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Title |
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Phone |
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Date |
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Form 21Cc (rev. 4/12)
Statement to Correct Information Previously Submitted
South Dakota Department of Labor and Regulation, Unemployment Insurance Division
PO Box 4730 • Aberdeen, SD
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Employer |
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Amount Reported on Original Return |
Correct Amount |
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Qtr/Yr to |
Total Wages |
Wages Paid in |
Total Wages |
Wages Paid in |
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Social Security # |
Employee Name |
be Corrected |
Paid This Quarter |
Excess of $_________ |
Paid This Quarter |
Excess of $_________ |
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