Free lb0755Rev9.06New Address.pmd - Tennessee


File Size: 33.9 kB
Pages: 1
File Format: PDF
State: Tennessee
Category: Workers Compensation
Author: CC30218
Word Count: 77 Words, 795 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.state.tn.us/labor-wfd/Employers/forms/LB-0755.pdf

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TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT

SOCIAL SECURITY NUMBER CORRECTION
Wage Records Unit 220 French Landing Drive Nashville, Tennessee 37243 Phone: (615) 741-3280 Fax: (615) 741-7214

This form should be used to correct social security numbers incorrectly reported on the Wage Report (LB-0851). Name of Employer __________________________________________ Employer Address ________________________________________ ________________________________________ ________________________________________ Employer Account No. ____________________ Federal ID No. __________________________

( ) Phone No. ______________________________

Signature ________________________________________

Quarter/Year

SSN as reported

Wages

Correct SSN

Name of Employee

LB-0755 (R. 9/06)

RDA N/A