Form Conn Uc-5a - Correction Of Employer Contribution Return - Connecticut Department Of Labor Page 3

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STATE OF CONNECTICUT
CORRECTION OF EMPLOYEE QUARTERLY EARNINGS REPORT
CONTINUATION SHEET
DEPARTMENT OF LABOR
UC 5A (CORR.) 5/98
EMPLOYMENT SECURITY DIVISION
EMPLOYER TRADE NAME (Type or print)
QUARTER / YEAR
CONNECTICUT REGISTRATION NUMBER
PAGE NUMBER
1.
EMPLOYEE
2.
NAME OF EMPLOYEE
3.
WAGES AS
4.
CORRECT
5.
INCREASE
6.
DECREASE
LISTED ON
AMOUNT OF
SOCIAL SECURITY
TYPE OR PRINT
ORIGINAL
WAGES
NUMBER
First Initial, Last Name
REPORT
7.
TOTAL FOR THIS PAGE

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