Looking for a Delaware Department Of Labor Forms And Templates? Download it for free!

Transmitter Report For Magnetic Media Filing (Quarterly Summary Assessment Report) - Delaware Department Of Labor

Appendix B

TRANSMITTER REPORT FOR

MAGNETIC MEDIA FILING

Quarterly Summary Assessment Report

1. Name and Address of Transmitter

2. DE Employer Account No(s).

(Include Street, City, State & Zip):

____ _______ ____ ___ ___ -___

(list any additional accounts below or a separate sheet)

____ ___ ___ -___

3. Tax Yr

____

Quarter

5. Name and Address of Person to Contact About

4. Number & Type of Reporting

Magnetic Media Filing (Include Street, City,

Medium in File

State and Zip):

__________________________ Magnetic

Cartridge

6. Telephone Number

7. Date Sent

8. Name and Address of Person to Whom

9. Transmitters Magnetic Media Inventory

Magnetic Media File is to be Returned:

Numbers

Comments:

___________________________________________________________________________________

_________________________________________________________________________________________

Please send a completed copy of this form with every magnetic media

Send Completed Magnetic Media to:

Delaware Department of Labor

Division of Unemployment Insurance, QPR-1

P.O. Box 9953

Wilmington, DE 19809-0953

Transmitter Report For Magnetic Media Filing (Quarterly Summary Assessment Report) - Delaware Department Of Labor