Employer Status Report Form
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Download Employer Status Report Form
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Box Last Name City Title State Last Name City Title State Last Name City Zip Code Zip Code Title State Zip Code SSN or FEIN () Phone SSN or FEIN () Phone SSN or FEIN () Phone Be Sure That All Applicable Items Are Completed Before Signing I certify that the information entered on this form is true and accurate, and that I am authorized by the named employing unit to complete this report for determining unemployment tax liability..
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