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Get MI UIA 1019 2011

Nd Blvd., Suite 12-450, Detroit, MI 48202 www.michigan.gov/uia Reset Form AMENDED WAGE DETAIL REPORT 1.  EMPLOYER NAME & ADDRESS 2.  UIA ACCOUNT NO. 5.TOTAL GROSS WAGES REPORTED ON THE ORIGINAL FORM UIA 1017 $ 6.  REASON FOR THE AMENDMENT: 3.  FEDERAL EMPLOYER IDENTIFICATION NO. 4.  QUARTER ENDING DATE (ACTUAL) TOTAL GROSS WAGES $ FOR THIS QUARTER PLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING THIS SECTION PART A PART B List only th.

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