Laserfiche WebLink
A <br />6. EMPLOYER NAME AND ADDRESS (SEE ITEM 24 FOR CHANGES TO NAME, ADDRESS, ETC.) <br />MENDEL 76 SOUTHEAST TX INVESTMENTS,; LLC <br />DBA PIPELINE GRILL 4601 GARTH ROADi SUITE #101, <br />BAYTOWN, TX 77521-2418 <br />11111110 0 <br />You must FILE this return even though you <br />had no payroll this quarter. If you had no <br />payroll show "V' in Item 13 mid sign the <br />declaration (Rom 25) an this form. <br />0 111111111111IS"I *-j"WIVIIII 11117111111111 IVAN 4:10131111 <br />st MgDID <br />""h 3rd Marini <br />195 2116 <br />195 <br />7, j 7 <br />111. SHOW THE COUNTY CODE <br />(see list on the beck or C4 <br />, 'u, You had a'. <br />term) in h <br />12. 9 u have employees in <br />mom tram one county in <br />TMS, how man are oulsid <br />y <br />23. The sum of all age totals must equal Item 13L <br />LI <br />TEXAS WORKFORCE COMMISSION <br />P,O. BOX 149037 <br />AUSTIN, TEXAS ?8714-0057 <br />greatest number of amployeas= <br />the counly shown In Item 117 <br />10. Enterin the boxes above the number ..employees both full41me and <br />822039870 <br />6. EMPLOYER NAME AND ADDRESS (SEE ITEM 24 FOR CHANGES TO NAME, ADDRESS, ETC.) <br />MENDEL 76 SOUTHEAST TX INVESTMENTS,; LLC <br />DBA PIPELINE GRILL 4601 GARTH ROADi SUITE #101, <br />BAYTOWN, TX 77521-2418 <br />11111110 0 <br />You must FILE this return even though you <br />had no payroll this quarter. If you had no <br />payroll show "V' in Item 13 mid sign the <br />declaration (Rom 25) an this form. <br />0 111111111111IS"I *-j"WIVIIII 11117111111111 IVAN 4:10131111 <br />st MgDID <br />""h 3rd Marini <br />195 2116 <br />195 <br />7, j 7 <br />111. SHOW THE COUNTY CODE <br />(see list on the beck or C4 <br />, 'u, You had a'. <br />term) in h <br />12. 9 u have employees in <br />mom tram one county in <br />TMS, how man are oulsid <br />y <br />23. The sum of all age totals must equal Item 13L <br />LI <br />TEXAS WORKFORCE COMMISSION <br />P,O. BOX 149037 <br />AUSTIN, TEXAS ?8714-0057 <br />greatest number of amployeas= <br />the counly shown In Item 117 <br />10. Enterin the boxes above the number ..employees both full41me and <br />26. 1 DECLARE that the Information herein <br />part-time, In pay <br />'dods that include 12th day of the calendar month. <br />DOLLARS CENTS 14s.= <br />Mark box with anW ifireponingwagos; <br />SIGNATURE <br />(ENTER WHOLE NUMBERS ONLY) <br />to another state during The year for <br />Nd <br />IS. Tax Due (Multiply Taxable Wages, 6772 68 <br />Item #14. by your Tax Rate of <br />Tax Rate includes: <br />0 A Ul Obligation Assessment rate of. <br />0 An Empl ent and <br />Training ormessment Rate of. <br />• <br />0211=1!1�7 ��- <br />I B. Balance Due from Prior Periods <br />(Subtract Credit Or Add Debit) <br />Include payment voucher with remittance, <br />20. SOCIAL SECURITY IST 2ND 21. EMPLOYEE NAME <br />NUMBER INIT INIT LAST NAME <br />ILVIAWTBAAf <br />s. F1 <br />CASHIER <br />23. The sum of all age totals must equal Item 13L <br />LI <br />TEXAS WORKFORCE COMMISSION <br />P,O. BOX 149037 <br />AUSTIN, TEXAS ?8714-0057 <br />h 11 <br />DO NOT STAPLE REPORT <br />(Write Accou al No. On Check) <br />MEND1602 01112119 09:28 01112119 08:28 <br />26. 1 DECLARE that the Information herein <br />is true and correct to the beat of my <br />6772i68 <br />knowledge, <br />SIGNATURE <br />X111--F—Lf f 111 a t e -d P a rY n—LAILAILlaw w- 01/12 <br />PREPARER'S <br />NAME — TINA HOFFMAN <br />PREPARER'S <br />-PRnN1FAtW <br />,For assistance please contact, <br />typuarounableto leangayonline, <br />mall report anTremil Ince to: <br />CASHIER <br />23. The sum of all age totals must equal Item 13L <br />LI <br />TEXAS WORKFORCE COMMISSION <br />P,O. BOX 149037 <br />AUSTIN, TEXAS ?8714-0057 <br />FORM " 24. Use Envelope STATUS CHANGE FORM to make address and ownership changes, <br />P <br />emni"Copy <br />DO NOT STAPLE REPORT <br />(Write Accou al No. On Check) <br />MEND1602 01112119 09:28 01112119 08:28 <br />