Form DE428C "De 428t Protest Sample Form" - California

What Is Form DE428C?

This is a legal form that was released by the California Employment Development Department - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the California Employment Development Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DE428C by clicking the link below or browse more documents and templates provided by the California Employment Development Department.

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Download Form DE428C "De 428t Protest Sample Form" - California

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Employment Development Department
Contribution Rate Group
PO Box 826831
Sacramento CA 94230-6831
DE 428T PROTEST SAMPLE FORM
This is the suggested format for filing a protest to the Statement of Charges to Reserve Account, DE 428T.
You must send your protest within 60 days from the date on the DE 428T to the address above. For additional
information and detailed instructions on how to file a protest, visit the Employment Development Department
(EDD) website at www.edd.ca.gov/Forms/ and refer to the Information Sheet: Statement of Charges to Reserve
Account,
DE
428I.
EMPLOYER
Enter Total Number of
PAYROLL TAX
Claimants Protested
-
-
ACCOUNT NUMBER
Check to update your
Business Name
mailing address.
Check if you want the
EDD response sent to the
Doing Business As (DBA)
address provided in your
protest letter.
Business Mailing Address (Number, Street, Box Number)
Business Mailing Address (City, State, ZIP Code)
Contact Person
Phone Number
This is a protest to the Statement of Charges to Reserve Account, DE 428T, dated __________________, 20___,
for the fiscal year ended June 30, 20___, for the following claimant(s):
SOCIAL SECURITY
CLAIMANT NAME
CLAIM DATE
EMPLOYER
NUMBER (SSN)
CHARGE AMOUNT
1
2
3
4
5
Please explain the protest reason for each claimant listed above. Type or print clearly. If more space is needed,
attach a separate page. Supporting documents must be labeled with the claimant’s SSN and arranged in the
same order as the protested claimants.
Signature
Title
Date
DE 428C Rev. 39 (7-18) (INTERNET)
Page 1 of 1
CU
Employment Development Department
Contribution Rate Group
PO Box 826831
Sacramento CA 94230-6831
DE 428T PROTEST SAMPLE FORM
This is the suggested format for filing a protest to the Statement of Charges to Reserve Account, DE 428T.
You must send your protest within 60 days from the date on the DE 428T to the address above. For additional
information and detailed instructions on how to file a protest, visit the Employment Development Department
(EDD) website at www.edd.ca.gov/Forms/ and refer to the Information Sheet: Statement of Charges to Reserve
Account,
DE
428I.
EMPLOYER
Enter Total Number of
PAYROLL TAX
Claimants Protested
-
-
ACCOUNT NUMBER
Check to update your
Business Name
mailing address.
Check if you want the
EDD response sent to the
Doing Business As (DBA)
address provided in your
protest letter.
Business Mailing Address (Number, Street, Box Number)
Business Mailing Address (City, State, ZIP Code)
Contact Person
Phone Number
This is a protest to the Statement of Charges to Reserve Account, DE 428T, dated __________________, 20___,
for the fiscal year ended June 30, 20___, for the following claimant(s):
SOCIAL SECURITY
CLAIMANT NAME
CLAIM DATE
EMPLOYER
NUMBER (SSN)
CHARGE AMOUNT
1
2
3
4
5
Please explain the protest reason for each claimant listed above. Type or print clearly. If more space is needed,
attach a separate page. Supporting documents must be labeled with the claimant’s SSN and arranged in the
same order as the protested claimants.
Signature
Title
Date
DE 428C Rev. 39 (7-18) (INTERNET)
Page 1 of 1
CU