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Get MI UIA 1488 2015

The State of Michigan Unemployment Insurance, or if you wish to revoke or change your current Power of Attorney representation. Please read the instructions on page 2 before completing this form. PART 1: EMPLOYER INFORMATION Name and Address (if individual) If a business, enter DBA, trade or assumed name. Telephone Number (required) Extension FEIN Number Fax Number UI Account Number ** E-mail Address (if applicable) PART 2: REPRESENTATIVE INFORMATION AND AUTHORIZATION DATES Your authorize.

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