Form Me. Fx-3 - Application For Termination Of Coverage Form - Maine Department Of Labor Page 2
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1
2INSTRUCTIONS FOR COMPLETING FORM
Application
for
Termination
of Coverage, Form Me. FX- 3, should be
prepared in triplicate.
All
items
must
be
completed.
Mail original
and
one copy on or before January 31 of the year the termination is effective,
to the Department
of Labor,
Bureau of Unemployment
Compensation,
and
A
duplicate
copy
of
the
application
will
be returned
retain
one
copy.
indicating approval or denial.
If the employer has more than one type of employment, all applicable
portions of sections 4 and 5 must be completed.
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