FOURTH QUARTER CONTRIBUTION REPORT FOR (APRIL, MAY, JUNE)

 

NAME OF DISTRICT ACCOUNT #650 NO. /EMPLOYEES FILING STATUS   PAYMENT FOR QUARTER ENDING JUNE 30 REPORT PREPARED BY DATE   1. GROSS WAGES paid to all covered employees to date during the Fiscal Year. $ (only numbers) 2. LESS any wages include in No. 1 above, paid during fiscal year excess of $7,000 paid to each employee. $ (only numbers) 3. TOTAL fiscal year to date taxable wages subject to contributions (item No. 1 minus item No.2) $ (only numbers) 4. YEAR TO DATE CONTRIBUTION due Trust (Multiply amount on line 3 by your rate of ( % ). $ (only numbers) 5. LESS Contribution paid in prior(s) to Tennessee School Boards Unemployment Compensation Trust. $ (only numbers) 6. AMOUNT DUE THIS QUARTER (subtract line 5 from line 4). $ (only numbers)

Payment of the amount entered on line (6) should be made on the 10th of the month following the end this calendar quarter. Send report to Tennessee School Boards Unemployment Compensation Trust. Print a copy for your files. Thank you for your cooperation. MAKE CHECK PAYABLE TO AND REMIT TO: