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* 1. Employer Name:

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* 2. What is your PA UC account number?
(Please note this is a 7 digit account number: 12-34567)

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* 3. What were your total employee count for each month below?

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* 4. What were your taxable wages (representative of the first $10,000 paid to an employee during the calendar year)?

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* 5. What were the employer contributions due?

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