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Get 459-487 Employer Request For Penalty Waiver.indd

Yer Request for Penalty Waiver Section A: Employer information (Type or print clearly in dark ink. Illegible forms may be returned to applicant. This could delay your request.) Employer name Employer number Requestors name Phone number ! Reason for waiver request (attach additional information if necessary) Signature of employer representative (do not print) Date Section B: Type of penalty Statement date q Late reporting q Late remittance Report due date Report submission date Paymen.

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