"Address Change Request Form" - Rhode Island

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Download "Address Change Request Form" - Rhode Island

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Address Change Request Form
In Rhode Island, all unemployment insurance (UI) benefits are fully taxable and must be reported
with your annual tax return.
In order to be sure that the Department has accurate address information so that you receive
your 1099G, we require current address information
if you have moved since the last time you received unemployment insurance benefits in
2009,
you believe the Unemployment Insurance Service Center (UISC) may have an incorrect
mailing address for you on your 2009 payment file.
If either of these is the case, please complete this form and return to the UISC address listed
below by January 18, 2010. Please print clearly.
By completing the following information, I hereby notify the Department of Labor and
Training that I have moved. My new mailing address is:
Last four digits of your SSN: xxx-xx-___________
First Name:_________________Middle Initial:___Last Name:________________________
Date of Birth:_______
Street:_________________________________________Apt. Number__________________
City:__________________________________
State:________ Zip:_________
Please return this form to:
Unemployment Insurance Service Center
PO Box 20380
Cranston, RI 02920
Address Change Request Form
In Rhode Island, all unemployment insurance (UI) benefits are fully taxable and must be reported
with your annual tax return.
In order to be sure that the Department has accurate address information so that you receive
your 1099G, we require current address information
if you have moved since the last time you received unemployment insurance benefits in
2009,
you believe the Unemployment Insurance Service Center (UISC) may have an incorrect
mailing address for you on your 2009 payment file.
If either of these is the case, please complete this form and return to the UISC address listed
below by January 18, 2010. Please print clearly.
By completing the following information, I hereby notify the Department of Labor and
Training that I have moved. My new mailing address is:
Last four digits of your SSN: xxx-xx-___________
First Name:_________________Middle Initial:___Last Name:________________________
Date of Birth:_______
Street:_________________________________________Apt. Number__________________
City:__________________________________
State:________ Zip:_________
Please return this form to:
Unemployment Insurance Service Center
PO Box 20380
Cranston, RI 02920