Tq01a Alaska Quarterly Contribution Report Change Notification Sheet
ADVERTISEMENT
1Alaska Quarterly Contribution Report
Change Notification Sheet
ALASKA DEPARTMENT OF LABOR
AND WORKFORCE DEVELOPMENT
(
Return this page only if you have changes listed below.)
PO BOX 115506
JUNEAU, AK 99811-5506
TDD—Relay Alaska: (800) 770-8973
Toll-Free: (888) 448-2937
RETURN SERVICE REQUESTED
Phone: (907) 465-2757
Fax: (907) 465-2374
Name and Address:
Complete the information below:
Date:
Account Number:
Federal ID Number:
Quarter Ending Date:
Page 1 - Change Notification Sheet
Page 3 - The Alaska Quarterly Contribution Report
Page 2 - Instructions
Page 4 - Alaska Map with Geographic Codes
If you have changes in any of the information below, please complete and return this page. If you need clarification
esd_tax@labor.state.ak.us
or assistance, contact your Field Office or Central Office as listed below or email at
Anchorage Employment Security Tax Office
Fairbanks Employment Security Tax Office
Juneau Employment Security Tax Office
(907)269-4850
(907)451-2876
(907)465-2787
Kenai Employment Security Tax Office
Wasilla Employment Security Tax Office
(907)283-2920
(907)352-2535
Toll-Free Telephone Number to connect to your Field Tax Office: 1-888-448-2937
Toll-Free Telephone Number to connect to Central Office in Juneau: 1-888-448-3527 or locally (907)465-2757
Toll-Free Telephone Number to connect to Relay Alaska for TDD/TTY: 1-800-770-8973 or voice 1-800-770-8255
ADDRESS CHANGES
Mailing Address
______________________________________________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Physical Address
_______________________________________________________________
_______________________________________________________________
TELEPHONE NUMBER CHANGE ___________________________________
ADD/CHANGE FAX NUMBER
___________________________________
ADD EMAIL ADDRESS
___________________________________
CLOSE ACCOUNT, CONTINUING BUSINESS WITH NO EMPLOYEES
DATE LAST WAGES PAID
___________________________________
CLOSE ACCOUNT, DISCONTINUED BUSINESS, NO SUCCESSOR
DATE LAST WAGES PAID
___________________________________
NAME CHANGE
_____________________________________________ EFFECTIVE DATE_______________
FEDERAL ID NUMBER CHANGE ____________________________________ EFFECTIVE DATE_______________
OWNERSHIP CHANGED, DATE ____________________________________
_______________________________________________________________
(New Owner's Name & Address
___
_______________________________________________________
_______________________________________________________
EXPLANATION OF OWNERSHIP AND FEDERAL ID NUMBER CHANGES________________________________
_______________________________________________________________________________
_______________________________________________________________________________
PAGE 1 OF 4
TQ01A 2/09
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal