- Date Quarter Ended - Enter the quarter ending date for the wage distribution. Forms C-83 are
needed for each quarter in the year of acquisition plus four prior years. If the business being
acquired does not go back four (4) years, then Forms C-83 are needed back to when the business
first began.
- Page No. of Pages - Enter the number of this page within the total page number series.
- Successor Information - Enter successor name, mailing address, and account number.
- Predecessor's Information - Enter predecessor name, mailing address and account number.
- Column 1 - Enter individual employee nine-digit social security numbers for employee's being
transferred. The list must be in ascending SSN order. See attached example.
- Column 2 - Enter employee's first initial, second initial, and last name of each employee being
transferred.
- Column 3 - Enter the total wages as reported by the predecessor on the Form C-4 (Wages List).
The total in this column will be distributed between Column 4 and Column 5.
- Column 4 - Enter the total wages for each employee being transferred to the successor.
- Column 5 - Enter the total wages for each employee being retained by the predecessor.
- Footings for this page - Enter the totals for Columns 3, 4, and 5.
- Total Wages for This Quarter - Enter the total wages as reported by the predecessor on Line 13
of the Form C-3 (Employer's Quarterly Report) in Column 3. Allocate the amount in Column 3 (total
wages amount) between Column 4 (wages applicable to the successor) and Column 5 (wages retained
by the predecessor).
- Total Taxable Wages for This Quarter - Enter the total taxable wages as reported by the predecessor
on Line 14 of the Form C-3 (Employer's Quarterly Report) in Column 3. Allocate the amount in Column
3 (total taxable wages amount) between Column 4 (taxable wages applicable to the successor) and
Column 5 (taxable wages retained by the predecessor).
- Prepared By/Phone No/Ext - Enter preparer information.