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Get In 54244 / Dwd 640p 2017

DES (State Information Data Exchange System) CONFIDENTIAL RECORD PURSUANT TO IC 22-4-19-6, IC 4-1-6 For more information and to register visit in.gov/dwd/sides.htm *This agency is requesting the disclosure of the claimant's Social Security Number in accordance with IC 4-1-8-1; disclosure is mandatory and this record cannot be processed without it. Name of Claimant Social Security Number Benefit Year End Claimant Street Address, City, State and ZIP Code Indiana SUTA (Employer Account Numbe.

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