Form Uc-8c - State Of Delaware Unemployment Insurance - Delaware Department Of Labor

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STATE OF DELAWARE UNEMPLOYMENT INSURANCE
Use this form to report changes in status or corrections to pre-printed information
DELAWARE DEPARTMENT OF LABOR
DIVISION OF UNEMPLOYMENT INSURANCE
P.O. BOX 41785
PHILADELPHIA, PA 19101-1785
permanently
Covered employment was
discontinued on
Date
permanently
Operations were
discontinued on
Date
Business reorganized effective
Date
Business sold on
Date
Name change/correction
(
)
-
Telephone number
Mailing Address
(OUTSIDE REPRESENTATIVE MUST FILE A POWER OF ATTORNEY)
Change in ownership interest
Please explain
If the Federal ID shown,
is incorrect, please print correct number here.
X
Signature of owner or duly authorized representative
Title
Date
Form UC-8C Doc. No. 60-06/00/11/01
CHANGE REPORT

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