Form Esd-Ark-209c - Continuation Sheet For Form 209b - 1990
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1CONTINUATION SHEET FOR FORM 209B
ESD ID Number ______________________________
Date Quarter Ended ______________________________
Page _____ of _____
Employer _____________________________________________________________
Town _______________________________________
SOCIAL SECURITY NUMBER
FIRST NAME, MIDDLE INITIAL & LAST NAME OF EMPLOYEE
TOTAL WAGES PAID
1) ______ ____ __________
_____________________ _____ _________________________________
$ __________ . _____
2) ______ ____ __________
_____________________ _____ _________________________________
$ __________ . _____
3) ______ ____ __________
_____________________ _____ _________________________________
$ __________ . _____
4) ______ ____ __________
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$ __________ . _____
5) ______ ____ __________
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6) ______ ____ __________
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7) ______ ____ __________
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8) ______ ____ __________
_____________________ _____ _________________________________
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9) ______ ____ __________
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10) ______ ____ __________
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$ __________ . _____
11) ______ ____ __________
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12) ______ ____ __________
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13) ______ ____ __________
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14) ______ ____ __________
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15) ______ ____ __________
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16) ______ ____ __________
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17) ______ ____ __________
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18) ______ ____ __________
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19) ______ ____ __________
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20) ______ ____ __________
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21) ______ ____ __________
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22) ______ ____ __________
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23) ______ ____ __________
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24) ______ ____ __________
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25) ______ ____ __________
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26) ______ ____ __________
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27) ______ ____ __________
_____________________ _____ _________________________________
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28) ______ ____ __________
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29) ______ ____ __________
_____________________ _____ _________________________________
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30) ______ ____ __________
_____________________ _____ _________________________________
$ __________ . _____
$
TOTAL WAGES FOR THIS PAGE
____________ . _____
ESD-ARK-209C
(REV. 10-90)
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