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To: Program Support Unit
Central Office Workforce Services Division, MIC 50
Employment Development Department
Mail: P.O. Box 826880
Sacramento, CA 94280-0001
Fax: 916-654-7921
Email: WARNNotice@edd.
REQUEST TO ASSIGN OR CHANGE LOCATION CODE
DATE OF REQUEST
NAME OF SUBRECIPIENT
NAME OF REQUESTOR
PHONE NUMBER OF REQUESTOR
|LOCATION CODE |ADDRESS RESPONSE CAN BE SENT TO: |FAX NUMBER RESPONSE CAN BE SENT TO: |ADD, DELETE, CHANGE |
|(SUBRECIPIENT CODE – 00): | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|__ __ __ - __ __ | | | |
|Add = New Location Code, address and fax number. |
|Delete = Delete Location Code and corresponding address and fax number. |
|Change = Location Code previously assigned remains the same, but change is made to address or fax number or both. |
Authorized Signature of Requestor Date
Authorized Signature of Subrecipient Administrator Date
................
................
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