Request To Amend Unemployment Compensation Quarterly Tax Return Form printable pdf download

Request To Amend Unemployment Compensation Quarterly Tax Return Form

OHIO DEPARTMENT OF JOB AND FAMILY SERVICES

P.O. Box 182404

Columbus, Ohio 43218-2404

(614) 466-2319

FOR 0064

REQUEST TO AMEND UNEMPLOYMENT COMPENSATION QUARTERLY TAX RETURN

1. Employer Account Number

2. Quarter

3. Year

4. Employer Name

First

Middle

5. Employee's Last Name

6. Total Wages Paid this Quarter

7. Weeks

Initial

Enter the Social Security Number of the employee as originally filed.

If amending Social Security Number, enter the correct number.

Enter only the item to be amended (see items 5 - 7). If amending multiple items, you must complete a separate record for each item being amended.

Amendment

Comments:

Reason #

Enter the Social Security Number of the employee as originally filed.

If amending Social Security Number, enter the correct number.

Enter only the item to be amended (see items 5 - 7). If amending multiple items, you must complete a separate record for each item being amended.

Amendment

Comments:

Reason #

Enter the Social Security Number of the employee as originally filed.

If amending Social Security Number, enter the correct number.

Enter only the item to be amended (see items 5 - 7). If amending multiple items, you must complete a separate record for each item being amended.

Amendment

Comments:

Reason #

Page 2 of 3

JFS 20129 (9/2010)

Request To Amend Unemployment Compensation Quarterly Tax Return Form