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Address for De9adj 1 Form 2013
(PLEASE PRINT)
YEAR / QUARTER
BUSINESS NAME
EMPLOYER ACCOUNT NO.
ADDRESS
CITY, STATE, ZIP CODE
REASON FOR ADJUSTMENT
(1)
SECTION II:
ADJUSTMENT TO WAGES AND CONTRIBUTIONS
(2)
Previously reported
Should have reported
(3)
DIFFERENCES
Debit/(Credit)
0.00
0.00
B. UNEMPLOYMENT INSURANCE (UI) Taxable Wages .........
0.00
0.00
C. STATE DISABILITY INSURANCE (SDI) Taxable Wages .....
0.00
0.00
D. EMPLOYER’S UI CONTRIBUTIONS (UI Rate 0.00 % times B)...
0.00
0.00
E. EMPLOYMENT TRAINING...
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