Form Ncui 685 - Adjustment To Employer'S Quarterly Tax & Wage Report - 2017 Page 2

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Page _____ of _____
North Carolina Department of Commerce
Division of Employment Security
Unemployment Insurance
Adjustment to Employer's Quarterly Tax and Wage Report-Continuation
1. Employer's Name:
Account Number(s):
2.
Quarter/Year:
3.
4. (a) SSN
(b) Employee's Name
(c) As Reported
(d) As Corrected
Total:
Total:
NCUI 685-A (Rev. 02/2012)

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