Form LM-10 Employer Report Part 2
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Form LM-10 Employer Report Part 2 Form. This is a Official Federal Forms form and can be use in US Dept Of Labor.
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Tags: Form LM-10 Employer Report Part 2, LM-10, Official Federal Forms US Dept Of Labor,
Part B
Name of Reporting Employer:
Check Item Number (from Page 2)
to which this Part B applies
9.a.
Agreement
File Number E-
ITEM 8.a
Payment
ITEM 8.b
Both
9.b. Name and address of person with whom or through whom a
separate agreement was made or to whom payments were
made.
ITEM 8.c
ITEM 8.d
ITEM 8.e
ITEM 8.f
9.c. Position In labor organization or with employer (if an independent
labor consultant, so state).
9.d. Name and address of firm or labor organization with whom
employed or affiliated.
Name
Organization
P.O. Box, Building and Room Number, if any
P.O. Box, Building and Room Number, if any
Street
Street
City
City
State
ZIP Code + 4
10.a. Date of the promise, agreement, or arrangement pursuant to
which payments or expenditures were agreed to or made.
State
ZIP Code + 4
10.b. The promise, agreement, or arrangement was:
Oral
Written*
Both
(*Written agreements entered into during the fiscal year must be attached.)
11.a. Date of each payment or
expenditure ( mm/dd/yyyy ).
11.b. Amount of each payment
or expenditure
11.c. Kind of each payment or expenditure (Specify whether
payment or loan, and whether in cash or property)
12. Explain fully the circumstances of all payments, including the terms of any oral agreement or understanding pursuant to which they were made.
Form LM-10 - Part B (2003)
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