Fillable QUARTERLY WAGE & TAX REPORT - AMENDMENT FORM

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QUARTERLY WAGE & TAX REPORT - AMENDMENT FORM

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QUARTERLY WAGE & TAX REPORT - AMENDMENT FORM (LWC ES51/WEB)
This form can be mailed or faxed to the UI Tax Accounting/Adjustment Department at (225) 346-6071
Questions regarding this form may be directed to the UI Tax Accounting/ Adjustments Unit at (225) 342-2961
1. STATE ID. NO. 2. FEDERAL I. D. # 3. YEAR / QUARTER 4. EXPERIENCE RATE %
5. EMPLOYER NAME, D.B.A. & ADDRESS This form is used to correct errors made on previously
filed quarterly reports. Please print and review the
instructions for completing this form prior to entering
any data.
6. Wages as Originally Reported 7. Wages as Amended
ORIGINAL TOTAL WAGES
AMENDED TOTAL WAGES
ORIGINAL EXCESS WAGES AMENDED EXCESS WAGES
ORIGINAL TAXABLE WAGES AMENDED TAXABLE WAGES
CONTRIBUTIONS PAID $ AMENDED CONTRIBUTIONS DUE $
11. REASON FOR AMENDMENT:
8. Amount overpaid
$
9. Amount underpaid $
10. Amount of remittance
( MAKE CHECKS PAYABLE TO THE OFFICE OF UI Administration. DO NOT SEND CASH OR CHANGE)
If you have overpaid and the overpayments are less than or equal to $500, the tax overpayment will print on the next
quarterly report due. A Tax Overpayment notice will be issued prior to the due date of the next quarterly report due if the
amount exceeds $500. If the account is no longer active, a refund will be issued automatically. If you have underpaid, include
interest and penalty due in the total remittance. Interest is calculated at 1% per month, or a percentage thereof. Penalty is
calculated at 5% per month not to exceed 25%. A Tax Delinquent notice will be issued if the underpayment is not paid in full.
COMPLETE THIS SECTION IF EMPLOYEE WAGES HAVE INCREASED OR DECREASED
12. SOCIAL SECURITY NO. 13. EMPLOYEE NAME 14. ORIGINAL TOTAL WAGES 15. AMENDED TOTAL WAGES
Use the Continuation sheet for Amended Wages to list
additional employees .
Total Total
I CERTIFY THE INFORMATION GIVEN IS TRUE AND CORRECT. MAIL TO: LOUISIANA WORKFORCE COMMISSION
(Unsigned amended forms will not be processed) OFFICE OF MANAGEMENT & FINANCE
ADJUSTMENTS UNIT
16. SIGNATURE: DATE: P.O. BOX 94100
BATON ROUGE, LOUISIANA 70804
TITLE: PHONE:
LWC-ES51/web Rev. 04/12
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QUARTERLY WAGE & TAX REPORT - AMENDMENT FORM

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Completed 4 January 2021

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