Record Of Unemployment Insurance Claims Filed And Checks Received

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RECORD OF UNEMPLOYMENT INSURANCE CLAIMS FILED AND CHECKS RECEIVED
To the claimant: record each continued claim submitted and each unemployment check received. You will know how
your UI account stands. If you fail to receive a check, we can make a proper investigation based on your record.
Continued Claims Information
Check Information
Date mailed/called
Week ending
Wages reported
Amount of check
Date received

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