Form Des 1060 R - New Hampshire Employment Security - Payment Voucher

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PAYMENT VOUCHER
NEW HAMPSHIRE EMPLOYMENT SECURITY
REPORT OF EARNINGS FOR LESS THAN FULL-TIME WORK
(Note: This Report Must Be Prepared in Ink and Wages Reported On A Calendar Week Basis)
Name of Employee _________________________________________________
SSN _________________________________________________
Week Beginning Sunday ____________________________________________
And Ending Saturday ___________________________________
1.
Gross Earnings for Hours Worked
$ _______________________
2.
Tips Reported by Employee
$ _______________________
5. Did the employee accept all the work you had for them
o
o
3.
Holiday Pay
$ _______________________
during the week this voucher covers?
Yes
No
4.
Total
$ _______________________
5a.If no, please explain: _________________________________
____________________________________________________
Co Name: ________________________________Tel #: ___________________
__________________________________________________
__________________________________________________
Completed By: __________________________________/_________________
__________________________________________________
Name (Print)
Title
Signature: _________________________________________/______________
___________________________________________________
Date
DES 1060 R-5/00
SEE INSTRUCTIONS ON REVERSE SIDE
PAYMENT VOUCHER
NEW HAMPSHIRE EMPLOYMENT SECURITY
REPORT OF EARNINGS FOR LESS THAN FULL-TIME WORK
(Note: This Report Must Be \Prepared in Ink and Wages Reported On A Calendar Week Basis)
Name of Employee: _______________________________________________
SSN: ________________________________________________
Week Beginning Sunday ___________________________________________
And Ending Saturday _________________________________
1.
Gross Earnings for Hours Worked
$ ______________________
2.
Tips Reported by Employee
$ ______________________
5. Did the employee accept all the work you had for them
o
o
3.
Holiday Pay
$ ______________________
during the week this voucher covers?
Yes
No
4.
Total
$ ______________________
5a. If no, please explain: ____________________________
_________________________________________________
Co. Name: _____________________________________Tel.# ______________
_________________________________________________
_________________________________________________
Completed By: __________________________________/__________________
_________________________________________________
Name (Print)
Title
Signature: _____________________________________/__________________
_________________________________________________
Date
DES 1060 R-5/00
SEE INSTRUCTIONS ON REVERSE SIDE
PAYMENT VOUCHER
NEW HAMPSHIRE EMPLOYMENT SECURITY
REPORT OF EARNINGS FOR LESS THAN FULL-TIME WORK
(Note: This Report Must Be Prepared in Ink and Wages Reported On A Calendar Week Basis)
Name of Employee _________________________________________________
SSN ___________________________________________
Week Beginning Sunday ____________________________________________
And Ending Saturday _____________________________
1.
Gross Earnings for Hours Worked
$ _______________________
2.
Tips Reported by Employee
$ _______________________
5. Did the employee accept all the work you had for them
3.
Holiday Pay
$ _______________________
during the week this voucher covers?
4.
Total
$ _______________________
5a. If no, please explain: ___________________________
________________________________________________
Co. Name: _______________________________Tel #:____________________
________________________________________________
________________________________________________
Completed By: _____________________________/______________________
________________________________________________
Name (Print)
Title
Signature: ________________________________/______________________
________________________________________________
Date
DES 1060 R-5/00
SEE INSTRUCTIONS ON REVERSE SIDE

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