KANSAS DEPARTMENT OF LABOR
          www.dol.ks.gov

          EMPLOYER ADJUSTMENT TO                                                                                              RETURN TO:            Examining Unit
                                                                                                                                                    Kansas Department of Labor
          QUARTERLY WAGE REPORT                                                                                                                     401 SW Topeka Boulevard
                                                                                                                                                    Topeka, KS 66603-3182
          K-CNS 111 (Rev. 6-2018)                                                                                             If no tax is due
                                                                                                                                      FAX TO:       785-291-3425
                                                                           TYPE OR PRINT CLEARLY
   INSTRUCTIONS:  K-CNS 111 is used to amend a previously filed "Quarterly Wage Report & Unemployment Tax Return, K-CNS 100".  Complete this form and send the original 
   to the address listed above, keep a copy for your records.  If you have questions regarding the completion of this report, you may call your nearest unemployment tax    
representative or the Examining Unit in Topeka at 785-296-5027.  This is not a toll-free call.  You may also e-mail to KDOL.UITax @ks.gov.  Further instructions are on page 2.
1. Employer Name and Address                                          2. Quarter                        3. Reason for Adjustment

                                                                          Year

4. Account Number                                    5. Rate               %  6. Page              of   7.
                                                                                               Pages      Signature                                                  Date
8. Social Security 9. Name                                                    10.              Total Wages                        11.               Excess Wages
   Number                (Last, First, M.I.)                                  10.a    Reported          10.b     Correct          11.a     Reported            11.b Correct
                                                                                                   0.00
                                                                                                   0.00
                                                                                                   0.00                                                 0.00
                                                                                                   0.00                       0.00
                                                                                                                                                        0.00

                                                                                                                                                        0.00                   0.00
                                                                                                                                                                               0.00

   Total - This page                                                                           $ 0.00                      $ 0.00                       $ 0.00              $ 0.00
   Total - Continuation Sheets                                                                 $ 0.00                      $ 0.00                       $ 0.00              $ 0.00
          AGENCY USE                                 12. Grand Total             12.a          $ 0.00   12.b               $ 0.00 12.c                  $ 0.00 12.d         $ 0.00
Deposit                                              13. Total Wage Difference                 . . . . . . . . . . . . . .             $ 0.00                  AGENCY USE
Code 13                                              14. Excess Wage Difference                    . . . . . . . . . . . .             $ 0.00                  Date Received
Code 14                                              15. Net Difference Taxable Wages                 . . . . . . . .                  $ 0.00
Contri.                                              16. Tax Due or Overpaid           . . . . . . . . . . . . . . . .                 $ 0.00
                                                                                 Underpayment              Overpayment

                                                                      UNEMPLOYMENT TAX CONTRIBUTIONS
                                                     401 SW Topeka Blvd,  Topeka KS 66603-3182    Phone 785-296-5027