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Get Il Ui-28b 2009-2024

E: This form is to be used only for itemized information of individual wage reports affected by claim for refund. ASSIGNMENT NO.______________________ Account No. Employer Name (Do not use this space) Address This claim covers the year of _________ ONLY, on a calendar quarter basis. Worker's Social Security Number Name of Worker Quarter Ending 3-31 Total Wages Originally Reported Total Wages As Corrected Excess As Reported Quarter Ending 6-30 Excess As Corrected Total Wages Originall.

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