Form 5208 A - Quarterly Tax Report
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1▼
Quarterly Tax Report
▼
(Form 5208 A)
USE BLACK INK ONLY AND ALL CAPS
DO NOT COPY FORM – SEE INSTRUCTIONS
DO NOT STAPLE – USE PAPER CLIPS
PLEASE SEE INSTRUCTIONS FOR INFORMATION ON COMPLETING THIS FORM ON THE BACK OF THE 5208B. SUBMIT BUSINESS STATUS OR ADDRESS CHANGES
ON THE 5208C. REFER TO EMPLOYMENT SECURITY’S INTERNET SITE FOR MORE INFORMATION ON UI TAX FORMS AT OR CALL THE TOLL FREE
EMPLOYER HELPLINE AT 1-888-836-1900.
1) DUE DATE
2) FEDERAL ID NUMBER
3) UBI NUMBER
4) QTR ENDING DATE
M M D
D
Y
Y
M M D
D
Y
Y
5) BUSINESS NAME
6) ES REFERENCE NUMBER
7) PREPARER’S INFORMATION
MANDATORY FIELD - IF YOU DON’T HAVE
AN ES REFERENCE NUMBER YOU MUST
FIRST NAME
AREA CODE
PHONE NUMBER
ALSO SUBMIT A CHANGE FORM (5208C)
WITH NAME & ADDRESS COMPLETED
FAX NUMBER
LAST NAME
AREA CODE
NUMBER
PREPARATION DATE
M M D
D
Y
Y
NO PAYROLL THIS QUARTER
8)
COMPLETE #9 AND #10 BELOW AND MAIL OR FILE NO PAYROLL REPORTS VIA TOLL FREE EMPLOYER HELPLINE. 1-888-836-1900
12) TOTAL GROSS WAGES
9) SUM OF EXEMPT CORPORATE OFFICER EARNINGS
,
,
.
FROM QUARTERLY WAGE DETAIL (5208 B)
AND ALL EXERCISED STOCK OPTIONS THIS QUARTER
PAID FOR COVERED EMPLOYMENT THIS
QUARTER REPORTABLE TO WASHINGTON STATE
,
,
.
13) EXCESS WAGES
,
,
.
ENTER TOTAL WAGES PAID DURING THIS QUARTER
IN EXCESS OF $
(SEE INSTRUCTIONS)
PER EMPLOYEE
SINCE JANUARY 1 (SEE INSTRUCTIONS)
Includes out-of-state wages:
Yes
No
10) NUMBER OF CORPORATE OFFICERS
,
,
.
EXEMPT FROM COVERAGE THIS QUARTER
14) TAXABLE WAGES
SUBTRACT LINE 13 FROM LINE 12
,
15) UI TAX DUE FOR THIS QUARTER
,
,
.
MULTIPLY LINE 14 BY COMBINED
TAX RATE
(*SEE EXPLANATION BELOW)
16) EMPLOYMENT ADMINISTRATION FUND (EAF)
11) NUMBER OF EMPLOYEES OF ALL TYPES WHO
,
,
.
MULTIPLY TAXABLE
WERE PAID WAGES DURING THE PAYROLL PERIOD
WAGES (LINE 14) BY
WHICH INCLUDES THE 12TH DAY OF THE MONTH
(SEE INSTRUCTIONS)
17) TOTAL TAX AMOUNT DUE
,
,
.
1ST MONTH
2ND MONTH
3RD MONTH
ADD LINES 15 AND 16
,
,
,
,
,
.
18) LATE PAYMENT PENALTY
(SEE INSTRUCTIONS)
19) INTEREST
,
,
.
(SEE INSTRUCTIONS)
OFFICE USE ONLY
DATE RECEIVED
M M D
D
Y
Y
20) LATE REPORT PENALTY
,
,
.
(SEE INSTRUCTIONS)
RECEIVED BY
CLASS CODE
21) PRIOR BALANCE OR CREDITS
,
,
.
DTO
(SEE INSTRUCTIONS)
*
INCLUDED IN LINE 15 ABOVE:
22) AMOUNT DUE
,
,
.
EARNED TAX RATE
ADD LINES 17, 18, 19, 20, AND 21
SOCIAL COST
ADJUSTED REDUCTION AMOUNT
SOLVENCY SURCHARGE
23) AMOUNT REMITTED
,
,
.
MAKE CHECK PAYABLE TO EMPLOYMENT SECURITY
DEPARTMENT PLEASE WRITE ES REF# ON CHECK
MAIL THE COMPLETED TAX (A) & WAGE (B) REPORTS
AND YOUR CHECK TO:
EMPLOYMENT SECURITY DEPARTMENT
PO BOX 34729 SEATTLE, WASHINGTON 98124-1729
EMS 5208 A
(Rev. 8/06)
CC 7540-032-819
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