Get NY TC 403 HR 2016
Of Injury (SROI) filing. This completed for m and all attachments must be received w ithin the time frame noted above in the IMPORTA NT! message. Please print clearly. If you do not, we cannot process this form . Em ployer Inform ation Please print clearly. Attach an additional page if you have infor mation for more than (3) three employers. Basic or Alternate Base Period Total Quarterly Gross Wages Write in the total quarter ly gross w ages for each employer / quarter indicated. Refer to your.
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