"Adjustment Application Form" - Delaware

This fillable "Adjustment Application Form" is a document issued by the Delaware Department of Labor specifically for Delaware residents.

Download the PDF by clicking the link below and complete it directly in your browser or through the Adobe Desktop application.

ADVERTISEMENT

Download "Adjustment Application Form" - Delaware

747 times
Rate
(4.4 / 5) 45 votes
State of Delaware Department of Labor
Division of Unemployment Insurance
P. O. Box 9953
Wilmington, DE 19809
(302) 761-8482
ADJUSTMENT APPLICATION
Employer Name
State Account Number:
Dear Sir or Madam
We are amending Year-Quarter
for the above referenced company as indicated below
Total Wages Paid
1. Social Security No
2. Name of Employee
3. As Reported
4. Should Be
5. Totals
6. Difference (+or-) Column 4 Total - Column 3 Total
As Reported
Correctly Reported
Net Change
7. Total Gross Wages Paid in Quarter
8. Wages in Excess of $16,500
9. Taxable Wages
10. Contribution Due
11. Total Prior Payments
12. Credit
13. Balance Due - Check Attached
14. Reason for Adjustment:
All approved credits may be used on subsequent filings on line 6 of UC-8 for
Signature:
Title:
Date:
g:\acctmgmt\forms\adjapp
State of Delaware Department of Labor
Division of Unemployment Insurance
P. O. Box 9953
Wilmington, DE 19809
(302) 761-8482
ADJUSTMENT APPLICATION
Employer Name
State Account Number:
Dear Sir or Madam
We are amending Year-Quarter
for the above referenced company as indicated below
Total Wages Paid
1. Social Security No
2. Name of Employee
3. As Reported
4. Should Be
5. Totals
6. Difference (+or-) Column 4 Total - Column 3 Total
As Reported
Correctly Reported
Net Change
7. Total Gross Wages Paid in Quarter
8. Wages in Excess of $16,500
9. Taxable Wages
10. Contribution Due
11. Total Prior Payments
12. Credit
13. Balance Due - Check Attached
14. Reason for Adjustment:
All approved credits may be used on subsequent filings on line 6 of UC-8 for
Signature:
Title:
Date:
g:\acctmgmt\forms\adjapp
ADVERTISEMENT