Form Tadj - Correction Of Wage Item(S) Form

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EMPLOYER NUMBER
CORRECTION OF WAGE ITEM(S)
EMPLOYER NAME AND ADDRESS:
Alaska Department of Labor and Workforce Development
Employment Security Division
P.O. Box 115509, Juneau, AK 99811-5509
_______ QTR. /YR________
________ QTR. YR_______
________ QTR. /YR________
w _________QTR./YR_________
SOCIAL SECURITY
EMPLOYEE NAME
w
w
w
NUMBER
REPORTED
CORRECT
REPORTED
CORRECT
REPORTED
CORRECT
REPORTED
CORRECT
TOTALS:
EXPLANATION:
I CERTIFY that to the best of my knowledge, the foregoing information is true and correct.
Adj Keyed: __________
Batch #: __________
Date _________By____________________________ Title_______________________ Telephone No.______________
Checked By: __________
SUMMARY OF ADJUSTMENTS
TOTAL WAGES
TAXABLE WAGES
BATCH / ITEM
YR/QTR
RATE
REPORTED
CORRECT
DIFFERENCE
REPORTED
CORRECT
DIFFERENCE
TADJ (10/06)

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