STATE OF NEW MEXICO 
                DEPARTMENT OF WORKFORCE SOLUTIONS 
                                  401 Broadway, NE 
                                  PO Box 1928 
                Albuquerque, NM  87103 

                SURETY BOND TRANSMITTAL 

Date:_____________________________                   Employer #:_____________ 

Employer Name: ______________________________ 

DBA:________________________________________ 

Address:_____________________________________ 

City________________________St_________Zip_______________ 

Pursuant to Paragraph (3) of Subsection C of Section 51-1-13 NMSA 1978, as a reimbursable 
employer you must execute and file with the New Mexico Department of Workforce Solutions a 
surety bond. 

Indicate the amount of taxable wages paid each quarter for the preceding year ending December 
31. If no wages were paid for the preceding year, estimate the amount of taxable wages you will
pay for the succeeding four calendar quarters from the effective date of election. 

QUARTER ENDING                    TAXABLE WAGES 

MARCH 31                          $_________________ 

JUNE 31                           $_________________ 

SEPTEMBER 31                      $_________________ 

DECEMBER 31                       $_________________ 

          TOTAL                   $_________________ X 2.7% 

             =                    $_________________amount of surety to be filed 
                                                     with NMDWS. 

In order to satisfy this requirement, you may obtain a bond from your insurance company.

_____________________________________________        _________________________ 
Authorized Signature for employer                    Date 

Rev 07-07                                            s/n 001-0867 
ES-802OC