IW 147 REPORTING FORM

REPORTING FORM
Remittance Report - Month of:
Please list each employee in alphabetical order:

Employee #1
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #2
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #3
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #4
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #5
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #6
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #7
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #8
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #9
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Employee #10
Name

First NameLast Name
Social Security Number
Total Hours Worked
Vacation
Gross Wages
W/D Deduction at 7% gross

Grand Total (all employees combined)
Grand Total Hours Worked*
Grand Total Vacation*
Grand Total Gross Wages *
Grand Total W/D Deduction at 7% gross *

1. General Fund
Working Dues Deduction at 7% of Gross*
Building Fund @ $.20 per hour*
Building Trades @ $.05 per hour*
Total to General Fund*

2. Apprentice Fund
Apprentice Fund @ $.72 per hour*
Training Fund @ $.10 per hour*
Total to Apprentice Fund*

3. Vacation fund
Vacation Fund @ $.50 per hour*

4. PAC Fund
PAC Fund @ $.12 per hour*

Contractor Information
Contractor*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Information
Name*

First NameLast Name
Title*
Date*

MonthDayYear
Date

Collapse Stopper
MAIL 4 SEPARATE CHECKS TO:

Ironworkers Local #147

6345 Innovation Blvd.

Ft. Wayne, IN 46818

MAKE CHECKS PAYABLE TO:

1) Ironworkers Local #147 General Fund

2) Ironworkers Local #147 Apprentice Fund

3) Ironworkers Local #147 Vacation Fund

4) Ironworkers Local #147 PAC Fund

BENEFITS

Pension, Health and Welfare & IMPACT are paid on hours worked.

Annuity will be based on hours paid

All benefits are to be paid to the Ironworkers District Council of Southern Ohio & Vicinity

1470 World Wide Place Vandalia, OH 45377-1156
Should be Empty: