Vermont Department of Labor 
Unemployment Insurance & Wages Division 
Employer Services Unit 
PO Box 488, Montpelier, VT 05601-0488 
(802) 828-4344 
                                        QUARTERLY WAGE REPORT 
EMPLOYER NO.    QUARTER ENDING DATE EMPLOYER NAME 

INDIVIDUAL EMPLOYEE WAGE DATA FOR THIS QUARTER (Please type or print entries) 
1. SOCIAL SECURITY                  2. EMPLOYEE'S NAME             3. TOTAL GROSS WAGES                5. HOURLY 6. GENDER
NUMBER                 (LAST, FIRST, MIDDLE INITIAL)                          PAID THIS QUARTER 4. H/S RATE      M / F 

7. PAGE      of                                        TOTAL WAGES 
                                                       THIS PAGE 
            THIS REPORT PAGE MUST BE RETURNED WITH A PROPERLY SIGNED AND DATED QUARTERLY 
                             WAGE & CONTRIBUTION REPORT (FORM C-101)   
Page 1 of 2                                                                                                 C-147 (11/17)

Vermont Department of Labor 
Unemployment Insurance & Wages Division 
Employer Services Unit 
PO Box 488, Montpelier, VT 05601-0488
(802) 828-4344 

                                 INSTRUCTIONS FOR FORM C-147 

This additional report form can be used when an employer has more employees than the original Quarterly Wage 
& Contribution Report (Form C-101) form can accommodate. 

Who Must File 

Every employer who is subject to the Vermont Unemployment Compensation Law (21 VSA). Inquiries on these 
instructions can be made by calling 802-828-4344. 

Due Dates 

The completed report forms should be returned with the Quarterly Wage & Contribution Report and must be 
returned or postmarked on or before the due date shown on the face of the Quarterly Wage & Contribution 
Report.  Complete each page by entering the Employer Account Number, the Quarter Ending Date, the Employer 
Name and the following information for each employee: 

ITEM 1      Enter employee's Social Security Number. 
ITEM 2      Enter the employee's last name, full first name, and middle initial. 
ITEM 3      Enter the total gross wages paid to the employee during the quarter. 
ITEM 4      Enter Hfor an   Hourly worker or Sfor a Salariedworker.  If S, skip to Item 6. 
ITEM 5      Enter hourly rate of pay.  If worker receives multiple rates, enter the predominant rate. 
            (For example, a worker works 15 hours at $7.00 per hour and 25 hours at $8.00;  enter $8.00. 
ITEM 6      Enter Ffor Female orMfor Male 
ITEM 7      Enter page number and total gross wages paid to all employees for the quarter for each page.  Total 
            of ALL pages should agree with the amount on ITEM 10 on the Employer's Quarterly Wage & 
            Contribution Report. 

Page 2 of 2                                                                                            C-147 (11/17)