"940-c Certification Request Form" - Mississippi

940-c Certification Request Form is a legal document that was released by the Mississippi Department of Employment Security - a government authority operating within Mississippi.

Form Details:

  • The latest edition currently provided by the Mississippi Department of Employment Security;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Mississippi Department of Employment Security.

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State of Mississippi
Department of Employment Security
P O Box 22781
Jackson, Mississippi 39225-2781
940-C CERTIFICATION REQUEST
Name and address of employer:
Date:________________________
__________________________
__________________________
Federal ID Number:____________
__________________________
__________________________
Account Number:______________
__________________________
__________________________
Please issue a 940-C Certification for the following year(s):
_________
_________
_________
_________
_________
________
CEO _________________________________
____________________________
Employer’s Signature
Title
Mississippi Department of Employment Security is an equal opportunity employer.
Auxiliary aids and services are available upon request to individuals with disabilities.
State of Mississippi
Department of Employment Security
P O Box 22781
Jackson, Mississippi 39225-2781
940-C CERTIFICATION REQUEST
Name and address of employer:
Date:________________________
__________________________
__________________________
Federal ID Number:____________
__________________________
__________________________
Account Number:______________
__________________________
__________________________
Please issue a 940-C Certification for the following year(s):
_________
_________
_________
_________
_________
________
CEO _________________________________
____________________________
Employer’s Signature
Title
Mississippi Department of Employment Security is an equal opportunity employer.
Auxiliary aids and services are available upon request to individuals with disabilities.