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LOUISIANA WORKFORCE COMMISSION
OFFICE OF UNEMPLOYMENT INSURANCE ADMINISTRATION
P.O. BOX 94100
BATON ROUGE, LOUISIANA 70804-9186
ATTN: TAX ACCOUNTING/ADJUSTMENTS
(225) 342 -2961 FAX (225) 346-6071
This document is semi-interactive. It may be filled out on-line but must be mailed or faxed in.
Employer Name & Address State ID. Number Year/Quarter
This form is a continuation of Lines 12 thru 15 of the
Quarterly Wage & Tax Report - Amendment Form.
12. Soc. Sec. Number 13. Employee Name 14. Original Total Wages 15. Amended Total Wages
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LWC ES 51A/WEB Last Rev.(04/12)
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AMENDED
CONTINUATION
WAGE LISTING
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Completed 4 January 2021

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