&l0O&l8c66p0e66f0L&k0G(0U(s1p8v1b0s4T&a13r147CD&a13.7r147CE&a14.4r147CP&a15.1r147CT&a16r147CU&a16.7r147CS&a17.2r168.6C=&a180.6C=&a192.6C=&a17.4r147CE&a45.9r54.9CL.&a99.9CM.&a192.9CN1.&a46r.3CNOTE -- IMPORTANT&a61r178.2C(N2)&a62r55.5CN2.&a63.8r.3CCADE3DP1(0U(s1p10v1b0s4T&a2r43CDE 3DP QUARTERLY CONTRIBUTION RETURN&a3r.2CH&a6.3r150.3CV&a6.4r150.6Cv&a8.8r150.3CV&a8.9r150.6Cv&a12r109.2CDO NOT ALTER THIS AREA&a18.8r100.3CV&a126.3CV&a152.3CV&a18.9r100.6Cv&a126.6Cv&a152.6Cv&a20.8r146.3CV&a20.9r146.6Cv&a22.8r146.3CV&a22.9r146.6Cv&a24.8r146.3CV&a24.9r146.6Cv&a26.8r146.3CV&a26.9r146.6Cv&a28.8r146.3CV&a28.9r146.6Cv&a30.8r69.3CV&a146.3CV&a30.9r69.6Cv&a146.6Cv&a34.8r69.3CV&a146.3CV&a34.9r69.6Cv&a146.6Cv&a38.8r146.3CV&a38.9r146.6Cv(0U(s1p12v1b0s4T&a63.8r106.6CFILE COPY ONLY(0U(s1p14v1b0s4T&a2.8r9.1CEDD&a5.9r98C.&a6.4r98.5C.&a8.4r98C.&a8.9r98.5C.&a18.4r65.4C.&a82.4C.&a99.3C.&a18.9r65.9C.&a82.9C.&a99.8C.&a20.4r95.4C.&a20.9r95.9C.&a22.4r95.4C.&a22.9r95.9C.&a24.4r95.4C.&a24.9r95.9C.&a26.4r95.4C.&a26.9r95.9C.&a28.4r95.4C.&a28.9r95.9C.&a30.4r45.9C.&a95.4C.&a30.9r45.7C.&a95.9C.&a34.4r45.9C.&a95.4C.&a34.9r45.7C.&a95.9C.&a38.4r95.4C.&a38.9r95.9C.&a43.9r68.4C(&a73.1C)(0U(s1p6v0b0s4T&a3.3r184CDO NOT ALTER PREPRINTED INFORMATION&a3.6r35CServing the People of California&a4.3r35CYou must FILE this return even though you had no payroll. If no payroll show "0" in item B, check no pay-&a4.8r35Croll box on this form and no payment enclosed box on envelope. Please sign the declaration on line K.&a5.6r351CYR&a367CQTR&a12.6r267Cl&a268Cl&a287Cl&a288Cl&a307Cl&a308Cl&a322Cl&a323Cl&a337Cl&a338Cl&a352Cl&a353Cl&a367Cl&a368Cl&a382Cl&a383Cl&a13.1r267Cl&a268Cl&a287Cl&a288Cl&a307Cl&a308Cl&a322Cl&a323Cl&a337Cl&a338Cl&a352Cl&a353Cl&a367Cl&a368Cl&a382Cl&a383Cl&a13.6r267Cl&a268Cl&a287Cl&a288Cl&a307Cl&a308Cl&a322Cl&a323Cl&a337Cl&a338Cl&a352Cl&a353Cl&a367Cl&a368Cl&a382Cl&a383Cl&a16.1r279CMo.&a298.5CDay&a320CYr.&a357.5CWIC&a16.6r254CEFFEC-&a17.1r257.5CTIVE&a17.6r256.5CDATE&a18.8r10CNUMBER OF EMPLOYEES earning wages during or receiving pay for the pay&a19.4r10Cperiods that include the 12th day of the calendar month (enter numerals only).&a19.5r198C1st&a262C2nd&a328C3rd&a20r10CPlease complete all fields. Blank fields will be identified as missing data.&a191CMonth&a256CMonth&a321CMonth&a24r10C(Individual Employee Wages to&a150Cper calendar year)(0U(s1p8v0b0s4T&a114C. . . . . . . . . . . . . . . . . . . . . . . . . . . (0U(s1p6v0b0s4T&a26r10C(Individual Employee Wages to&a150Cper calendar year)(0U(s1p8v0b0s4T&a114C. . . . . . . . . . . . . . . . . . . . . . . . . . . (0U(s1p6v0b0s4T&a30.7r100C(F1) DI Employee Contrib.&a205C(F2) DI Prev. Paid This Qtr.&a34.7r100C(G1) Total PIT Withheld&a205C(G2) PIT Prev. Paid This Qtr.&a40.7r380CD&a382.5CE&a385CPT&a41.1r380.5CUSE&a43.5r.5CSigna-&a129CTitle&a44.1r.5Cture&a129C(Owner&a248CPhone&a339CDate&a44.7r129CAccountant, Preparer, etc.)&a45.7r80CD&a82.5CE&a85CPT&a45.7r103CSOCIAL SECURITY&a202.5CEMPLOYEE NAME&a335CTOTAL WAGES PAID&a46.1r80.5CUSE&a101CACCOUNT NUMBER&a173.5CFirst Initial&a211.5CLast Name&a340CTHIS QUARTER&a61.4r.5CIndividual employees' wages are&a62r.5Creported on magnetic media.&a63.8r40CNTF 2187&a70CCopyright Forms Software Only, 1993 Nelco, Inc. N93CADE3(0U(s1p8v0b0s4T&a2r195CApproved Extension To&a3.3r66CPLEASE TYPE THIS FORM -&a5.7r119.1CDELINQUENT IF NOT&a217.2Cl&a6.4r21CQUARTER&a119.1CPOSTMARKED OR&a7.1r23.1CENDED&a74.7CDUE&a119.1CRECEIVED BY&a8r186.9CEmployer Account No.&a8.1r30CCHECK THIS BLOCK if changes are reported on the Request For Change form - refer to third pg.&a13.2r155.7CP1&a167.7CP2&a181.2CC&a190.2CP&a199.2CU&a208.2CS&a216.6CW&a226.2CA&a18.8r.3CA.&a22r.3CB.&a6CTOTAL SUBJECT WAGES PAID THIS QUARTER&a79.8C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . &a166.2C(B)&a23r.3CC.&a6CUNEMPLOYMENT INSURANCE TAXABLE WAGES (UI)&a24r46.5C$&a166.2C(C)&a25r.3CD.&a6CDISABILITY INSURANCE TAXABLE WAGES (DI)&a26r46.5C$&a166.2C(D)&a28r.3CE.&a6CEMPLOYER'S UI CONTRIB.&a49.4C. . . . &a90C% Times C&a106.4C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . &a166.2C(E)&a30r.3CE1.&a6CEMPLOYMENT TRAINING TAX&a90C% Times C&a106.4C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . &a166.2C(E1)&a31r.3CF.&a6CEMPLOYEE CONTRIBUTIONS (DI)&a31.5r109.5CLESS&a32r3.3CWITHHELD:&a40.2C% Times D&a163.5C=&a166.2C(F3)&a33r.3CG.&a6CCALIFORNIA PERSONAL INCOME TAX (PIT) WITHHELD&a35.5r109.5CLESS&a36r163.5C=&a166.2C(G3)&a37r.3CH.&a6CADJUSTMENT TO PRIOR QUARTERS&a38r16.5CA DE 938, QUARTERLY RETURN ADJUSTMENT FORM, MUST BE ATTACHED&a134.9C. . . . . . . . . . . . . . . . &a38.2r166.2C(H)&a39r.3CJ.&a6CTOTAL TAXES DUE (Add Items E, E1, F3, G3 and H)&a40.1r166.2C(J)&a40.2r6CMake check payable to EMPLOYMENT DEVELOPMENT DEPT. Bank No.&a41r6CINCLUDE EMPLOYER ACCOUNT NUMBER ON YOUR CHECK. Do not staple check to return.&a42.1r.3CK. BE SURE TO SIGN THIS DECLARATION: I DECLARE that the information herein is true and correct to the best of my knowledge and belief.&a47r1.5CUse form DE 3B, REPORT OF&a47.8r1.5CWAGES, instead of this form if;&a48.9r.3C1.&a5.1CYou have more than seven&a49.8r5.1C(7) employees, OR&a50.9r.3C2.&a5.1CYour employees are subject&a51.8r5.1Cto Unempl. Ins. only, OR&a52.9r.3C3.&a5.1CYour employees are subject&a53.8r5.1Cto Disability Insurance only.&a55.1r.3CPlease check the appropriate&a56r.3Cbox below:&a57.2r.3CNo payroll&a58.1r.3CEnter "0" on line B&a59.2r.3CFinal return&a60.1r.3CComplete page 3&a62r63CTotal of this page OR total of DE 3Bs attached&a63r.3CDE 3DP REV. 17 (9-93)&a40.2CState of California / Employment Development Department / P.O. Box 826847 / Sacramento CA 94247-0001(0B(s0p10h12v0s3b0T&a6.1r75.4CW&a6.3r75.2C|&a6.4r75.2C|&a8.6r75.4CW&a8.8r75.2C|&a8.9r75.2C|&a12r48.5C}}}}}}}}}}}}}}}}}}}}}}}}}}}}}&a77.1Cd&a77.1Cc&a77.3Cc&a77.3Cd&a77.5Cd&a77.5Cc&a12.5r48.5C}}&a13.5r48.5C}}&a14.5r48.5C}}&a15.5r48.5C}}&a16.5r48.5C}}&a17.5r48.5C}}&a18.6r50.4CW&a63.4CW&a76.4CW&a18.8r50.2C|&a63.2C|&a76.2C|&a18.9r50.2C|&a63.2C|&a76.2C|&a20.6r73.4CW&a20.8r73.2C|&a20.9r73.2C|&a21r58C}&a22r58C}&a22.6r73.4CW&a22.8r73.2C|&a22.9r73.2C|&a23r58C}&a24r58C}&a24.6r73.4CW&a24.8r73.2C|&a24.9r73.2C|&a25r58C}&a26r58C}&a26.6r73.4CW&a26.8r73.2C|&a26.9r73.2C|&a27r58C}&a28r58C}&a28.6r73.4CW&a28.8r73.2C|&a28.9r73.2C|&a29r58C}&a30r58C}&a30.6r34.9CW&a73.4CW&a30.8r34.7C|&a73.2C|&a30.9r34.7C|&a73.2C|&a31r58C}&a32r58C}&a33r58C}}}}}}}}}}}}}}}}&a34r58C}}}}}}}}}}}}}}}}&a34.6r34.9CW&a73.4CW&a34.8r34.7C|&a73.2C|&a34.9r34.7C|&a73.2C|&a35r58C}&a36r58C}&a37r58C}&a38r58C}&a38.6r73.4CW&a38.8r73.2C|&a38.9r73.2C|&a39r58C}&a40r58C}&a40.5r53.5Cj&a41r58C}}}}}}}}}}}}}}}}}}&a42r.1C}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}&a43r.1C}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}&a44r.1C}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}&a45r.1C}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}&a61r56C}}}}}}&a62r53.5Cj&a56C}}}}}}&a3.3r7C,,,,,,,,,,,,&a18.2C,,&a3.5r63C,,,,,,,,,,,,,,,&a5.2r7C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a5.4r7C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a6r69C,,,,,,,&a7.5r7.5C,,&a12.5C,,,,,,,,,,,,&a27.5C,,,,,,,,,,,,&a48.5C,,,,,,,,,,,,,,,,,,,&a69C,,,,,,,&a8.5r7.5C,,&a59.5C,&a60C,,,,,,,,,,,,,,,,&a10.5r59.5C,&a60C,,,,,,,,,,,,,,,,&a12.5r50.5C,&a51C,,,,,,,,,,,,,,,,,,,,,,,,,,,&a16.5r54.5C,,,,,,,,,,,,&a68.5C,,,,,,,,&a17.9r54.5C,,,,,,,,,,,,&a68.5C,,,,,,,,&a18.1r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a18.3r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a18.5r41C,,,,,,,,,,&a54C,,,,,,,,,,&a67C,,,,,,,,,,&a20.5r41C,,,,,,,,,,&a54C,,,,,,,,,,,,,,,,,,,,,,,&a22.5r59C,,,,,,,,,,,,,,,&a24.5r59C,,,,,,,,,,,,,,,&a26.5r59C,,,,,,,,,,,,,,,&a27.5r19.5C,,,,,,&a28.5r19.5C,,,,,,&a59C,,,,,,,,,,,,,,,&a29.5r19.5C,,,,,,&a30.5r19.5C,,,,,,,,,,,,,,,,&a40.5C,,,,,,,,,,,,,&a59C,,,,,,,,,,,,,,,&a31.5r7.5C,,,,,&a32.5r7.5C,,,,,&a19.5C,,,,,,,,,,,,,,,,&a40.5C,,,,,,,,,,,,,&a59C,,,,,,,,,,,,,,,&a34.5r19.5C,,,,,,,,,,,,,,,,&a40.5C,,,,,,,,,,,,,&a59C,,,,,,,,,,,,,,,&a36.5r19.5C,,,,,,,,,,,,,,,,&a40.5C,,,,,,,,,,,,,&a59C,,,,,,,,,,,,,,,&a38.5r59C,,,,,,,,,,,,,,,&a39r29C,,,,,,,,,,,,,,,,,,,,,,,&a40.5r38.5C,&a39C,,,,,,,,,,,,&a52C,,&a58C,,,,,,,,,,,,,,,,,,,,&a41.5r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a41.7r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a44.5r2.5C,,,,,,,,,,,,,,,,,,,,,,,&a29C,,,,,,,,,,,,,,,,,,,,&a48.5C,&a52.5C,,,,,,,,,,,,,,,&a70.5C,&a71C,,,,,,,&a45.3r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a45.5r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a46.5r16C,,,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a48.5r18C,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a50.5r18C,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a52.2r9.6C,,&a52.5r18C,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a54.2r12.9C,,&a54.5r18C,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a56.5r18C,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a58.5r18C,,,,,,,,,,,,,&a33C,,,,,,,,,,,,,,,,,,,,,,,&a58C,,,,&a64C,,,,,,,,,,,,,,&a60.5r18C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a62r45C,,,,,,,,,&a62.5r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a62.7r 0C,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,&a57.5r13.5COO&a58.5r13.5COO&a59.5r13.5COO&a60.5r13.5COO&a61.5r13.5COO&a62.5r13.5COO&a5.9r69Cx&a5.9r76Cx&a6r69c69Lx
