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No Wages paid for the quarter covering this report Step 1. Check Sold Business Name address and phone number of new owner applicable boxes Ceased Employing Last payroll date // and provide Change in Name Address Phone Number or Federal ID list corrections information Amended Report requested Step 2. Unemployment Insurance Employee Wage Listing Employee s Social Security Number Last Name Check here if wage listing is attached* Name of Employee First Name Total Wages Paid this Quarter Excess Wa ...

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