Form Uct-7878 - Wage Adjustment Report - 1997

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Unemployment Insurance
WAGE ADJUSTMENT REPORT
P. O. Box 7945
ADJUSTMENTS FOR
Madison, WI 53707
CALENDAR YEAR
(608) 266-6877
1. UI ACCOUNT NUMBER
EMPLOYER NAME
EMPLOYER ADDRESS
Quarter End
3/31
Quarter End
6/30
Quarter End
9/30
Quarter End
12/31
Date
Date
Date
Date
2. SOCIAL SECURITY NUMBER
3. LAST NAME
4. FIRST NAME
5. REPORTED
6. CORRECT
5. REPORTED
6. CORRECT
5. REPORTED
6. CORRECT
5. REPORTED
6. CORRECT
WAGES
WAGES
WAGES
WAGES
WAGES
WAGES
WAGES
WAGES
7. SIGNATURE
DATE
TITLE
PHONE NUMBER
RETURN TO: UNEMPLOYMENT INSURANCE, P.O. BOX 7945, MADISON, WI 53707
UCT-7878 (R. 4/97) (U00046)

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