Alaska Quarterly Contribution Report 
                               THE 202  TAXABLE WAGE BASE3FOR EACH EMPLOYEE IS $4 , 00                                                                          7 1

Quarter ending: 3/31/23                                            Due date:                                                                Employer account no: 

FEIN:                                                                                                                                                                                  If none enter "0" 
                                                                                                                     1. For each month, report the number
Name:                                                                                                                of workers who worked during or                               1st       2nd 3rd
Address:                                                                                                            received pay for the payroll period,                      Month    Month    Month 
                                                                                                                     which includes the 12  of the month.th

                                                                                                                     2. Total reportable wages paid this
                                                                                                                     quarter.  (See instructions, page 2)                      $ 

                                                                                                                     3. Less excess wages over the taxable
                                                                                                                     wage base.                                                ( ($$                      ) 

                                                                                                                     4. Taxable wages paid this quarter.                       $                 0.00
                                                                                                                                                             Employer's rate 
A report must be filed even if no wages are paid for the                                                             5. Employer's contribution                                $                 0.00
quarter.                                                                                                                                                               % 
                                                                                                                                                             Employee's rate 
You may now file your quarterly contribution report                                                                  6. Employee's contribution                    0 1 .5 %    $                 0.00
online. Please visit our website located at 
labor.alaska.gov/estax or call (888) 448-3527. To amend                                                                                                         Total rate
your quarterly report, please submit a “Correction of                                                                7. Total contributions due                    0.51      % $                 0.00
Wage Item,” Form TADJ also available online. 
                                                                                                                     8. Amount remitted
Notice to employers: Wage information and other                                                                                                                                $ 

confidential UC information may be requested and                                                                     9. Wages reported to other states? See
utilized for other authorized governmental purposes,                                                                       instructions explaining this on page 2.                   Yes 
including, but not limited to, verification of an individual’s 
eligibility for other government programs.                          
                                                                                                                                                         *See area map for geographic location codes
                     10.                                                              11.                                                                12.                       13.           14. 
            Employee's                                        Employee’s name – type or print                                                  Reportable wages                    Full          Geographic 
         Social Security                                           (Do not list more than once.)                                               paid this quarter.              occupational      code * 
                  Number                             Last                               First                        M.I.                   (No negative wages)                title or code 
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                                                     DO NOT provide double-sided pages for wage detail 
Make checks payable to Alaska Department of Labor and Workforce Development.                                                        15. Total number         16. Total reportable wages - all pages
         If you have any questions, call toll free (888) 448-3527                                                                   of pages                        (Same total as in block 2 above.)
                           or email esd.tax@alaska.gov. 

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

Signed:                                                                                        Title:                                                                           Date: 

Printed name:                                                                         Phone: (          )                                                Email: 

Alaska Department of Labor and Workforce Development, Employment Security Tax, P.O. Box 115509, Juneau AK 99811-5509                                                
                                                                                                                                                                                                 TQ01C (1/23)