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) Lag Date EMPLOYER STATUS REPORT For UNEMPLOYMENT COMPENSATION 713 Other Rate(s) Quarter(s) Predecessor Reg. No.: Date Rec d RETURN COMPLETED FORM TO: FORM IS TO BE TYPED OR PRINTED IN INK PLEASE COMPLETE AND RETURN THIS FORM EVEN THOUGH YOU MAY NOT BE SUBJECT TO THE CONNECTICUT UNEMPLOYMENT COMPENSATION LAW. *501(C)(3) NON-PROFIT ORGANIZATIONS SHOULD REQUEST FORM UC.

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