Form Uc-252 - Pennsylvania Unemployment Compensation Wage Records Page 2

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TO TRANSFER
EMPLOYEE
GROSS QUARTERLY WAGES PAID AND CREDIT WEEKS APPLICABLE TO PART TRANSFERRED
DATE
S.S. NO. AND NAME
___QTR ______ ___QTR ______ ___QTR ______ ___QTR ______ ___QTR ______ ___QTR ______ ___QTR ______ ___QTR ______
___QTR ______
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
S.S. NO.
$
$
$
$
$
$
$
$
$
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
CREDIT
NAME
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
WEEKS
UC-252 REV 5-07 (Page 2)

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