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Dol3c Form 2014
Address
Total Tax Rate
DOL Account Number
.
Qtr / Yr
Q / Y Y Y Y
Correction
End Date
M M / D D / Y Y Y Y
Federal I.D. Number
SECTION B
DOL-4N, Item 2
Total Reportable Gross Wages
DOL-4N, Item 3
Non-Taxable Wages
PLEASE INCLUDE YOUR DOL
ACCOUNT NUMBER ON ALL CHECKS
AND CORRESPONDENCE
DOL-4N, Item 4
Taxable Wages
SECTION C
Social Security No.
Employee’s Full Name
Pages
Individual Quarterly Wages Reported And Corrected
Total Reportable Gross Wages
Reported
Taxable...
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