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Payer’s Name and Address
Department of Labor and Workforce Development
Division of Employment Security
Special Services Unit
Nashville, Tennessee 37243
Payer’s Federal ID Number
62-6001445
Claimant’s Social Security Number
411-04-8383
Claimant’s Name
SONDRA G IERUBINO
Claimant’s Current Address*
PO BOX 443
SALE CREEK ,TN 37373
Unemployment Compensation (UC) Payments
$3,087.00
Trade Readjustment Assistance (TRA) Payments
$0.00
Alternative Trade Adjustment Allowance (ATAA) Payments
$0.00
Total Payments
$3,087.00
UC Federal Income Tax Withheld
$162.00
TRA Federal Income Tax Withheld
$0.00
ATAA Federal Income Tax Withheld
$0.00
Total Federal Income Tax Withheld
$162.00
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