Form Er-66 - Schedule A - Application For Partial Transfer Of Experience - 2005

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APPLICATION FOR PARTIAL TRANSFER OF EXPERIENCE
SCHEDULE A
Allocation of Quarterly Taxable Wage Totals
We, the undersigned, do hereby certify that the information given below is, to the best of our
knowledge, true and correct, and we submit said information as part of the Application for Partial
Transfer of Experience under Section 1507 B of the Illinois Unemployment Insurance Act
TRANSFEREE
TRANSFEROR
Employer Account No. __________________
Employer Account No.___________________
Business Name ________________________
Business Name ________________________
Signed By ____________________________
Signed By ____________________________
Official Title __________________________
Official Title __________________________
Date Signed __________________________
Date Signed __________________________
1
2
3
4
Balance of
TAXABLE Wages
TAXABLE Wages
TAXABLE Wages
QUARTER ENDING
Reported by
Atributable to
Attributable to
PREDECESSOR
TRANSFEREE
TRANSFEROR
(Col. 2 less Col. 3)
9-30-
12-31-
3-31-
6-30-
9-30-
12-31-
3-31-
6-30-
9-30-
12-31-
3-31-
6-30-
ER-66 (Rev. 3-05)

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