Alaska Quarterly Contribution Report Form - 2001
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1
2Alaska Quarterly Contribution Report
Change Notification Sheet
ALASKA DEPARTMENT OF LABOR
AND WORKFORCE DEVELOPMENT
(Return this page only if you have changes listed below.)
PO BOX 025506
JUNEAU, AK 99802-5506
Page 1 - Change Notification Sheet
Page 3 - The Alaska Quarterly Contribution Report
Page 2 - Instructions
Page 4 - Alaska Map with Geographic Codes
If you have changes in any of the information below, please complete and return this page. If you need clarification
or assistance, contact your Field Office or Central Office as listed below or email at esd_tax@labor.state.ak.us
Anchorage Employment Security Tax Office
Fairbanks Employment Security Tax Office
Juneau Employment Security Tax Office
(907)269-4850
(907)451-2876
(907)465-2787
Kenai Employment Security Tax Office Nome
Employment Security Tax Office
Wasilla Employment Security Tax Office
(907)283-4478
(907)443-3037
(907)373-2682
Toll-Free Telephone Number to connect to your Field Tax Office: 1-888-448-2937
Toll-Free Telephone Number to connect to Central Office in Juneau: 1-888-448-3527 or Locally (907)465-2757
Toll-Free Telephone Number to connect to Relay Alaska for TDD/TTY: 1-800-770-8973 or voice 1-800-770-8255
o
ADDRESS CHANGES
Mailing Address
______________________________________________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Physical Address
_______________________________________________________________
_______________________________________________________________
o
TELEPHONE NUMBER CHANGE
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ADD/CHANGE FAX NUMBER
o
CLOSE ACCOUNT, CONTINUING BUSINESS WITH NO EMPLOYEES
DATE LAST WAGES PAID
o
CLOSE ACCOUNT, DISCONTINUED BUSINESS, NO SUCCESSOR
DATE LAST WAGES PAID
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NAME CHANGE
EFFECTIVE DATE
o
FEDERAL ID NUMBER CHANGE
EFFECTIVE DATE
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OWNERSHIP CHANGED, DATE
(New Owner's Name & Address)
EXPLANATION OF OWNERSHIP AND FEDERAL ID NUMBER CHANGES
Name and Address:
Complete the information below:
Account Number:
Federal ID Number:
Quarter Ending Date:
PAGE 1 OF 4
TCONTB 1004-1a 02/01
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