SUPPLEMENTAL Alaska Quarterly Form 

         Use this form to add employees to a previously filed Quarterly Report. 
     To amend wages that have been reported, use the “Correction of Wage Item” form.  

Quarter ending:                                                      Liable Alaska employer 

Account number: 

1. Total reportable wages
                                         $                           Reporting agency 
     (See instructions)
2. Taxable wages paid this quarter       $ 
3. Total contributions                 % $ 
     d                                                               Power of Attorney filed with ESTax? 
4. Amount remitted                       $ 

                                                                     * See area code map for geographic location codes
         5. Employee’s      6. Employee’s name – type or print       7. Reportable wages 8. Full       9. 
         Social Security    (Don’t list employees more than once)    paid this quarter   occupational  Geographic 
         Number             Last               First              MI (No negative wages) title or code code * 

E 
     D 
N
     O 
C 
L 
     N
O
     O
S 
     T 
E 
     S
C 
     T 
H
     A
E 
     P
C 
     L 
K
     E 
S

              Make checks payable to:                10. Total number         11. Total reportable wages – all pages
Alaska Department of Labor and Workforce Development                 of pages (Same total as in Block 1)

              Questions: (888) 448-3527 

I hereby certify the information on this form is true and correct. 

Signed: _________________________________  Title: ________________________ Date: ______________ 
Printed name: ____________________________ Email: ___________________  Phone:  _( ____) _______               ____ 

Alaska Department of Labor and Workforce Development 
Employment Security Tax 
P.O. Box 115509, Juneau, AK 99811-5509
labor.alaska.gov/estax                                                                      TSUP (8/1 9)

2-Digit Code      2014 Census Area                                                                                      Alaska
Northern Region
31                North Slope Borough
33                Northwest Arctic Borough
34                Nome Census Area
Interior Region
41                Yukon-Koyukuk Census Area
44                Fairbanks North Star Borough
46                Southeast Fairbanks Census Area
47                Denali Borough
Southwest Region                                                                 North Slope
50                Dillingham Census Area
51                Kusilvak Census Area (formerly Wade Hampton)
52                Bethel Census Area
55                Bristol Bay Borough
57                Aleutians East Borough                               Northwest
58                Aleutians West Census Area
59                Lake and Peninsula Borough                              Arctic
Anchorage Region                                                                                                Fairbanks
61                Matnuska Susitna Borough                                                                      North Star
62                Municipality of Anchorage                                      Yukok-Koyukuk
Gulf Coast Region                                             Nome
71                Kenai Peninsula Borough
73                Kodiak Island Borough                                                               Southeast
75                Valdez-Cordova Census Area
79                Yakutat Borough                                                           Denali    Fairbanks
Southeast Region
85                Haines Borough
86                Juneau Borough                              Kusilvak                      Matanuska-
87                Sitka Borough                                                               Susitna Valdez-
88                Petersburg Borough
90                Prince of Wales-Hyder Census Area                    Bethel                         Cordova             Haines Skagway
95                Ketchikan Gateway Borough
96                Skagway Borough                                                                                                      Juneau
97                Wrangell Borough                                                          Kenai
98                Hoonah-Angoon Census Area                                      Peninsula                      Yakutat                   Petersburg
                                                                       Dillingham
99                Outside Alaska                                                                      Anchorage Hoonah-                      Wrangell
20                Marine                                                                                        Angoon
00                Received wages but did not work             Bristol Bay                                                        Sitka
                                                              Lake &
                                                              Peninsula
                                                                                 Kodiak Island
                                                                                                                          Prince of Wales-
                                                                                                                                 Hyder       Ketchikan
                                                                                                                                             Gateway
                                                              Aleutians East

                                Aleutians West