TEXAS WORKFORCE COMMISSION - WikiLeaks
|ADJUSTMENT REPORT |
|1. TWC Account number: |PURPOSE: |For TWC Use Only: |
|1 |This report shall be used to correct | |
|3 |amounts of total and/or taxable wages | |
|- |previously reported on Employer’s Quarterly| |
|2 |Report, Form C-3. | |
|7 |A separate report is required for EACH | |
|9 |calendar quarter adjusted. | |
|9 | | |
|3 | | |
|2 | | |
|- | | |
|6 | | |
| | | |
| | |Result of Audit? |( Yes / ( No |
|2. Employer’s Name and Address: | | | |
| | | | |
|STRATFOR ENTERPRISES LLC | | | |
|221 W 6TH ST, STE 400 | | | |
|AUSTIN, TX 78701 | | | |
| | |Column A Verified? |( Yes / ( No |
| | | | |
| | | |
| | | |
| | | |
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| | | |
| | | |
| | | |
| | |Mo. |
| | |Day |
| | |Year |
| | | |
| | |Postmark Date |
| | | |
| | |Dollars |
| | |Cents |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |Amount Received |
| | | |
| | |AE # |
| | | |
| | |Inits. |
| | | |
| |Individuals may receive, review, and | |
| |correct information that TWC collects about| |
| |the individual by emailing to: | |
| |open.records@twc.state.tx.us | |
| | | |
| |or writing to: | |
| | | |
| |TWC Open Records | |
| |101 East 15th St Rm. 266 | |
| |Austin, TX 78778-0001 | |
|3. Adjustment for the Quarter Ended: | |Wages List Adjustment |
|0 | | |
|9 | |( Keyed by WRCE ( Keyed by B-27 |
| | | |
|3 | |( Attached ( Not Attached ( Not Required |
|0 | | |
| | | |
|2 | | |
|0 | | |
|1 | | |
|1 | | |
| | | |
|Month | | |
| | | |
|Day | | |
| | | |
|Year | | |
| | | |
|Please note: Lines 4 and 5 must be completed for columns A, B and C, even if no changes are made for one of the items. |
|(If no change for an item, please enter the same figure in columns A and B, and show $0.00 for column C.) |
| ITEMS |A |B |C |
| |Amounts as Originally Reported on Form C-3 (or | |Difference |
| |previously adjusted on Form C-5) for this quarter: |Correct Amounts |Over Reported or Under |
| | | |Reported |
| | | |[Column A - Column B] |
| |Dollars . Cents__ |Dollars . Cents__ | |
|4. Total Wages Paid | |
|8. Penalty – If the original Employers Quarterly Report (Form C-3) was submitted more than 15 days late for this quarter, and the taxable|$0.00 |
|wages have changed (as shown in item 5C), calculate the difference in penalty amount due. Please see instruction sheet for details. | |
|9. Total for this | Underpayment: Attach remittance for the additional amount due. |$35,091.63 |
|Quarter |Overpayment: Amount will be reflected on your next tax report and can be used to offset future liabilities. | |
|IMPORTANT: This section must be completed for each form submitted |
|Indicate reason for adjustment: CHANGE IN ENTITY ON AUGUST 1, 2011 DID NOT RESULT IN A CHANGE IN CONTROL (COMMON OWNERSHIP WAS MAINTAINED). HOWEVER, WITHHOLDING WAS |
|ERRONEOUSLY REINITIATED ON WAGE BASE |
|If amounts reported on Form C-4 for any individual employee(s) are affected by the adjustment for this |Form C-7: |
|quarter, attach a Wages List Adjustment Schedule (Form C-7), showing adjustment of the total wages reported | |
|for each affected employee. | |
| | Submitted | Not Submitted |
I certify that all information in this Adjustment Report is true and correct:
|Signature: |Phone: (512 ) 744-4331 |
|Print Name: DON R. KUYKENDALL |Title: |Date: |
| |(Owner, Officer, Partner, etc.) | |
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