NC DEPT. OF COMMERCE                CONTINUATION SHEET FOR          
 DIVISION OF EMPLOYMENT SECURITY              REPORT OF EMPLOYEES WAGES 
            P. 0. BOX 26504 
           RALEIGH, NC 27611-6504 

                                                                                                                                   ACCOUNT NUMBER 
EMPLOYER NAME                                                  Page Number                                                                    
                                                      
                                  SOCIAL SECURITY              EMPLOYEE NAME                                                       WAGES PAID 
                                        NUMBER       INITIAL           INITIAL                          LAST NAME        SEASONAL  THIS QUARTER    
                             
 QUARTER - YEAR              
                                                                                                                                                   
 TYPE EMPLOYER               
 NAME, ACCOUNT                                                                                                                                     
 NUMBER, AND QUARTER-        
 YEAR AS SHOWN ON                                                                                                                                  
 FORM NCUI 101. 
                             
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                                                                                                                  14. PAGE TOTAL              
 
NCUI 101-B