DE r CONmiBUTION RETURN and lEPORT OF WAGES Under the UNEMPLOYMENT INSURANCE CODE
ItATTiIF CALIFORNIA, DEPARTMENT OF HUMAN RESOURCES DEVELOPMENT, 800 CAPITOL MALL,'; SACRAMENTO, CALIF. 95814
QUA1T1R UNDID MARCH 31,  19F0 DVi APHIL 1,  1970
Enter your account number as ii appears on
the original copy, and refer to this number in
any correspondence regarding this return.
YEAR
QTR.
701
030-2506
Employer Account No.
Korean National Associationof N.  America
1368 West Jefferson Blvd.           ~~          ~
Los Angeles,  Calif*  90007	
DELINQUENT IF NOT
MAILED BY
APRIL 30, 1970
You must FILE this return %ven though you had no
payroll this quarter. If you had no payroll show
"NQEE" in item J anisign the certificate.   „
Before Completing Items A thru R, See
Instructions on Attached Employer's Copy
Be Sure to Sign This Certificate
I CERTIFY That the information herein is true and
correct to the best of my knowledge and belief.
Signature of owner^ responsible officer, or au.h_r._N
Gem  Manager
Title
H.
J.
K.
EMPLOYEE CONTRIBUTIONS:
JAN. $   ^*88  FEB. $_
s   Total wages in subject employment.,
INDIVIDUAL EMPLOYEE
No, of employees earning wages during
A.  JAN.      ...__._..% FEB	
B
C
D
E.
F.
pay periods which include the 12th of:
---2.  MAR 2    .
|#a    Wages in excess of $3800
Taxable wages—(B minus C)
UNEMPLOYMENT INSURANCE *____
E      INDIVIDUAL EMPLOYEE
«    Wages from $3800 to $7400	
Taxable wages—(D plus E)
DISABILITY INSURANCE ...
2,237
2,23?
2.23?
50.
50
50
7*75
G    EMPLOYER CONTRIBUTIONS *
.   (Employer Rate times D) _„	
MAR. $.
.7.75
TOTAL $.
22,38
EMPLOYEE CONTRIBUTIONS PREVIOUSLY PAID                                                                     0% of F)
TQ THE DEPARTMENT FOR JAN. AND FEB.   .   .... __... $ .
EMPLOYEE CONTRIBUTIONS  DUE  (LINE  H  MINUS  LINE J)..
'list your employees below IF THERE
IS ENOUGH SPACE FOR All Of THEM.
You may single space to list as
many as 14 below* If this is not
enough space, LIST NONE BEIOW-
use Continuation Sheets 0I3B for
your ENTIRE tfST;
Conf/nuafion sheefs may be obtained from
any Employment Tax Office,
L.
Adjustment*.  Increase
Decrease..
Total (Add G, K and L)
Miotai {.Add Ij-, r. and L)
. PAY THIS AMOUNT
Bank No...
Make Check Payable to Dept. of HRD
76
m
22
too    70
32
38
THIS COPY
TO BE
RETAINED
BY
EMPLOYER
N. Social Security Account Number
P. Employee Name
Q. Total Wages Paid This Qtr.
000
00
0000
FIRST NAME
MIDDLE INITIAL
LAST NAME
DOLLARS
CENTS
~W
w
3126
.otuig
Hoi
Koo
1,937
50
m
12
6897
L«e
K_
Park
300
00
I   Total of this page OR total of continuation sheets attached.
**  (See Instructions)                .	
2t237
So
DE 3 QTR 70-1
M CAUTION i    USE LINE D WAGES IN COMPUTING EMPLOYER CONTRIBUTIONS
/ EST.  UI-0-452B_' 39380-457 t-70 405M (&D OSP