SCHEDULE B: Allocation of Worker's Quarterly
                        Taxable Wages for Quarter Ending       

Fax number:  217-557-1948                 Page No.         of         Pages

We, the undersigned, do hereby certify that the information given below and on any additional pages is, to the 
best of our knowledge, true and correct, and we submit said information as part of the Application for Partial 
Transfer of Experience under Section 1507B of the Illinois Unemployment Insurance Act. 

TRANSFEREE                                        TRANSFEROR
Employer Account No. ______________________ Employer Account No. ______________________ 

Business Name ____________________________ Business Name ____________________________ 

Signed By ________________________________  Signed By ________________________________ 

Official Title ______________________________ Official Title ______________________________ 

Date Signed _______________________________ Date Signed _______________________________ 
                                        Worker’s Wages Reported by         Worker’s 
                                          PREDECESSOR                      TAXABLE         Balance (if any) of 
Worker’s                                  EXCESS                           Wages           Worker’s TAXABLE 
Social Security                     TOTAL Wages (over         TAXABLE      Attributable to Wages Attributable 
Account Number    Name of Worker    Wages $          )         Wages       TRANSFEREE      to TRANSFEROR 
1                      2              3           4                5       6                  7

8. Totals for this page
9. Totals for All pages THIS quarter

ER-67 (Rev. 8-17)