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ER OR CORRECT BUSINESS NAME AND ADDRESS RETURN ORIGINAL WITHIN 10 DAYS GEORGIA DOL ACCOUNT NUMBER (If already assigned) 3. TRADE NAME 2. TYPE OF ORGANIZATION Individual 4. PRINCIPAL BUSINESS, FARM OR HOUSEHOLD LOCATION IN GEORGIA (Do not use a P. O. Box number) Street Address Corporation Nonprofit org. Other (specify) City Zip Code County GA 5. DATE FIRST BEGAN EMPLOYING WORKERS WITHIN STATE OF GA. DATE OF FIRST GA. PAYROLL 7. HAVE YOU... ( 6. ARE YOU LIABLE Yes FOR FEDERAL UNEM.

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