Correct        Wages
                                                                                                                                                                                                7.
                       P.O. Box 7945
                                    Madison, WI 53707

Unemployment Insurance                                                                                                                                                                          Reported       Wages
                                                                                                                                                                     4th Quarter ending 12/31   6.
                                                                                                                                                                                                                     Phone Number

                                                                                                                                                                                                Correct        Wages
                                                                     Fax: (608) 266-8089  PH: (608) 266-6877                                                                                    7.

                                                                                                                                                                                                Reported       Wages
                                                                                                                                                                     3rd Quarter ending 9/30    6.

                                                                                                                                                                                                Correct        Wages
                                                                                                                                                                                                7.

                                                                                                                                                                                                Reported       Wages
                                                                                                                                                                     2nd Quarter ending 6/30    6.
                                                                                                                                                                                                                                 Title

                                                                                                                                                                                                Correct        Wages
                                                                                                                                                                                                7.
                                                                                                                            Employer Name                                                                                                    

                                                                                                                                                                                                Reported       Wages
                                                                                                                                                                     1st Quarter ending 3/31    6.                               Date Signed
                                                                     Wage Adjustment Report

                                                                                                                                                                                                First Name
                                                                                                                                                                                                5.
                                                                                                                            UI Account Number

                                                                                                                                                                                                                                                     Return To: Unemployment Insurance, PO Box 7945, Madison, WI 53707 

                                                                                                                                                                                                Last Name
                                                                                                                                                                                                4.
                                                                                                                                                                                                                                             )6
                                                                                                                  
                                                                                                                                                                                                                                             /2010                                                                     6

                                                                                                                                                                                                                                                                                                                       N.  
                                                                                                                                                                                                                                              (
                                                                                                                                                                                                                                                                                                                       -E 
                                                                                                                                                                                                               Number
                                                                                                             Calendar Year:                                                                     Social Security
                                                                                                                            Account Number
                                                                                                                                                Employer Address     
                                                     Adjustments For                                         1.             2.                                                                  3.                   Signature
                                                                                                                                                                                                                     8.                      UCT-7878

Wage Report Adjustment Instructions 

Use this Wage Adjustment Report to adjust individual employee wages. 

Item 1   Enter the Calendar Year for which the adjustments will be applied. 

Item 2   If not already preprinted, enter your 14-digit SUITES Account number, your 10-digit  
             Wisconsin Unemployment Insurance Account number, your name and address. 

Item 3   Enter the Employee's Social Security Number. 

Item 4   Enter the Employee's Last Name. 

Item 5   Enter the Employee's First Name. 

Item 6   Enter the total wages previously reported, during this quarter, paid to the employee. 

Item 7   Enter the correct total wages, during this quarter, paid to the employee. 

Item 8   Signature, date, title and telephone number of preparer. 

Return To:   Unemployment Insurance 
         PO Box 7945 
         Madison WI 53707 

Return By Fax:  (608) 266-8089 

Changes to wage detail may also require corrections to your Quarterly UI              
Contribution Report. Make all changes to your Contribution Report on a              
Contribution Adjustment Report, Form UCT-7842-E.