W-118a (R. 11-21) Employer’s Wage Attachment Remittance Please reproduce this form and mail with future payments. Instructions. Complete and send with your payment to the address below. Use one line for each employee from whom you have withheld delinquent taxes. Do not include regular amounts of income taxes withheld. If payroll address has changed, enter new address below. Make checks payable to: Wisconsin Department of Revenue Mail remittance with this form to: Wisconsin Department of Revenue PO Box 8906 Madison WI 53708-8906 TERMINATED EMPLOYEE: You are required to withhold the entire amount payable to terminated employees or an amount equal to the balance of certification. Address City State Zip Entry required if it applies to an employee under a wage certification. Check whichever applies and enter the requested dates. Entry Required for Each Employee that had Delinquent Amounts Withheld This Period Check ONLY if this is the FINAL Payment of the Wage Attachment Name of Employee Employee’s Social Security Number Delinquent Amount Withheld Last Day of Work Anticipated Return Date (month - year) Terminated/ Quit Temporary Lay-Off Leave of Absence Employer’s name Payroll phone number ( ) - Contact person name TOTAL AMOUNT WITHHELD ...................................... $ Applicable Laws and Rules This document provides statements or interpretations of the following laws and regulations enacted as of November 15, 2021: secs. 71.65 and 71.91(7), Wis. Stats.

Employer’s Wage Attachment Remittance

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Page 1: Employer’s Wage Attachment Remittance

W-118a (R. 11-21)

Employer’s Wage Attachment RemittancePlease reproduce this form and mail with future payments.

Instructions. Complete and send with your payment to the address below. Use one line for each employee from whom you have withheld delinquent taxes. Do not include regular amounts of income taxes withheld.

If payroll address has changed, enter new address below.Make checks payable to: Wisconsin Department of Revenue

Mail remittance with this form to: Wisconsin Department of Revenue PO Box 8906 Madison WI 53708-8906

TERMINATED EMPLOYEE: You are required to withhold the entire amount payable to terminated employees or an amount equal to the balance of certification.

Address

City State Zip

Entry required if it applies to an employee under a wage certification.Check whichever applies and enter the requested dates.Entry Required for Each Employee that had Delinquent Amounts Withheld This Period Check ONLY

if this is the FINAL Payment of the Wage

AttachmentName of Employee

Employee’sSocial Security

Number

DelinquentAmountWithheld

Last Day of WorkAnticipatedReturn Date

(month - year)

Term

inate

d/Q

uit

Tem

pora

ryLa

y-Of

Leav

e of

Abse

nce

Employer’s name

Payroll phone number

( ) -Contact person name

TOTAL AMOUNT WITHHELD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Applicable Laws and RulesThis document provides statements or interpretations of the following laws and regulations enacted as of November 15, 2021: secs. 71.65 and 71.91(7), Wis. Stats.