Uihcwd

Fringe Benefits

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The State of New Jersey utilizes Box No. 14 of this Statement to provide its employees with information regarding items that may or may not impact the calculation of

Employee's Claim For Credit For Excess Ui/hc/wd And Disability

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Name: Address: City, State, Zip Code: 1A. Employer s Name: Fed. Emp. I.D. #: Private Plan #: Wages: B. Employer s Name: Fed. Emp. I.D. #: Private Plan #: Wages: