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Get IN DWD UC-5A 2010

-19-6, IC 4-1-6 A. Period Covered DOC Number C. TOTAL INDIANA PAYROLL - Total of Column 3 (Must agree with item 2 on Form UC-1) B. Total number of employees listed in column 2 D. Employer Information Account Number BATCH Number FEIN Number $ Location Code DO NOT USE THIS SPACE Quarter Employer Year (Check only one) Address 1 City State (1) Social Security Number 000 00 0000 2 3 4 ZIP Code (3) All Remuneration Including (2) Name of Employee (Please type or print) Excess.

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