Unemployment Insurance Assessment - General Inquiry

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant’s complete name?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's date of birth?  (Enter as MM/DD/YYYY)

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant’s complete mailing address?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 When was the last time the claimant updated her address? (Format as MM/DD/YYYY)

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's claim status?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's gender?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 How or who filed the latest claim?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 _______________________________________________________   P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE   3           * * *  L A S T   E M P L O Y E R   A D D R E S S E S  * * *             -------------------------:-------------------------:-------------------------   1) 0318062 NORTH MIAMI,  :                         :                             EPIXTAR MARKETING CORP   :                         :                            C/O ADP-UCS              :                         :                            PO BOX 6000              :                         :                             SAN DIMAS          CA    :                         :                            91773-9060               :                         :                            -------------------------:-------------------------:-------------------------Who is the last employer?  (Enter complete name.)

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 _______________________________________________________   P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE   3           * * *  L A S T   E M P L O Y E R   A D D R E S S E S  * * *             -------------------------:-------------------------:-------------------------   1) 0318062 NORTH MIAMI,  :                         :                             EPIXTAR MARKETING CORP   :                         :                            C/O ADP-UCS              :                         :                            PO BOX 6000              :                         :                             SAN DIMAS          CA    :                         :                            91773-9060               :                         :                            -------------------------:-------------------------:-------------------------What is the last employer's serial number?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's reason for separation?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's telephone number?  (Format as XXX-XXX-XXXX)

If the claimant has an alternate phone number, where can you find it?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 Was the last claim backdated? If so, how far?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 On what date was the claim processed? (Format as MM/DD/YYYY)

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 Does the claimant have federal withholding?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                           RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090________________________________________________________   P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE   4 BENEFIT YEAR:     090104 - 100103  PBY:       000000                     -ID-  APPEAL:          0------NO APPEAL  COMB WAGE:  0--------NO  DUA: NO     0100011 BALANCE-FLAG: 0--BALANCED          FED SUP:        ------------------          STD OCC CD:     00000000  NAICS:            561422  TENURE MONTHS:         020                                      TOTAL    KANSAS     FED    X-SRV                                      MONETARY ID:         B        A        A             REG-1                     REG-TBA:  3536     3536        0        0   0100101 BEGIN: 090104 END: 100102   REG-WBA:   136      100%       0%       0%         STATUS:  01--REG ENTITLED   REG-BAL:     0        0        0        0                                                                                         SERIAL/CHG FLG: 318062  1 CHG                                           0100601   BASE PERIOD WAGES:   11859.52                                                  NON MON CODE:                                                                  NON MON DATE:                                                                 WARRANT  DATE   WEEK           E   PAY  TYPE/            CEGARN/  PROC           NO.   MAILED CLAIMD EARNING  C   AMT  PROG  DISPOSITON SVBATCH  DATE  ---ID-- 5337417 090127 090110     .00  0   136  02 01 01         03 3091 090112 0100801 5314965 090123 090117     .00  0   136  11 01 01         03 3091 090120 0100801 5337417 090127 090124     .00  0   136  21 01 01         03 3091 090126 0100801 5396945 090204 090131     .00  0   136  21 01 01         03 3091 090203 0100801 5427350 090210 090207     .00  0   136  21 01 01         03 3091 090209 0100801 5471657 090217 090214     .00  0   136  21 01 01         03 3091 090216 0100801 Will the claimant receive a debit card if she files claim today?  

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's race?

P/C          XXXXXXXXX  NON INQUIRY  DATE: 07/24/09  TIME: 16:07:13   PAGE   1   REC ISSUE    BEGIN  END    PROC   PRINT   EMPL  EXM  DOU AP REC EMP OT DETECT   NO NO  CODE  DATE   DATE   DATE   DATE   SERIAL NO   AMT FL FLG CHR TE  DATE   01 01 91114 090104 000000 090107 000000 0000000 090 00000 0  0   0  00 090107   02 01 00000 090104 000000 090121 000000 0000000 114 00000 0  0   0  00 090107   03 02 93200 081218 000000 090107 000000 0318062 090 00000 0  0   0  00 090107   04 02 13221 081218 000000 090122 090123 0318062 114 00000 0  0   0  00 090107How many issues are on the NONI?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 What is the claimant's ethnic background?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE  1 SMITH, JANE D       ON VRU: YES         WITHHOLD: OFF                        I 12345 FIELDCREST DR        EFT-STATUS: 02=OFF EFT          PHONE: 620 555-1212 PITTSBURG          KS  66762-6307  MOTHER MAIDEN NAME: CULLISON                AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  037     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 1--WHITE       ETHNIC: 2-NONHISP  DATE OF BIRTH:  841001 INDUSTRY: 7389  SUB PAY: 000  CLMSRCE: 01  OWNER: 050   DR LIC #: KS K12345678 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS90114  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS090114  NAICS:            561422  TENURE MONTHS:         020 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  SMITH, JANE D             TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS:                                                    00000              * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  090104 090107 090607 090608 070423 081217 0318062 210 561422  090  31090 ______________________________________________ P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/24/09  TIME: 16:05:57   PAGE   2  GROUP:               211  STATUS:  0-CURRENT        WKS-INTERVAL:     00--10    GIVEN CODE:               GIVEN DATE:               PRIORITY:                0  CALL IN REASON:       01  CALL IN SCHEDULE:         CALL IN PRINTED:            REPORT DATE:              REPORT TIME:              FAIL RPT PRINTED:           ERS-GIVEN:             0  ER-GIVEN-CODE:            DEL LIST PRINTED:                                                                                            ------------- INFORMATION ON ER BY MAIL --------                                GROUP:               211  STATUS:  0-CURRENT        WKS-INTERVAL:     26--05    GIVEN DATE:       090107                                                         ER LETTER MAILED:         RETURN LETTER BY:                                     FAIL RESPD PRINT:                                                               MAIL-ERS-GIVEN:           ER-GIVEN-CODE:            TEMP TONIGHT:       NO     Does the claimant have to look for work?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/29/09  TIME: 12:43:24   PAGE   1 DOE, WILLIE A                  ON VRU: YES         WITHHOLD: OFF              P 123 HASKELL AVE             EFT-STATUS: 02=OFF EFT          PHONE: 913 555-5641 KANSAS CITY        KS  66104-0000  MOTHER MAIDEN NAME: HARRIS                  AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  209     RES CITY:  2091    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 2--BLACK       ETHNIC: 2-NONHISP  DATE OF BIRTH:  731015 INDUSTRY: 9900  SUB PAY: 000  CLMSRCE: 07  OWNER: 050   DR LIC #: KSK123  TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS70109  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS070109  NAICS:            485410  TENURE MONTHS:         001 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  DOE, WILLIE A             TERM: UPDT  DATE: 05/15/09  TIME: 19:29:25  ADDRESS: 3159 ROWLAND AVE            KANSAS CITY        KS  66104-             * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  061217 061218 070108 070109 061213 061218 2018695 210 564222  126  11026 2)I-N  070617 070617 070619 000000 000000 000000 0000000 000 000000  000  90099 3)I-N  070701 070701 070703 000000 000000 000000 0000000 000 000000  999  90099 4)R-N  090510 090514 090514 090515 090401 090413 2102228 210 485410  347  31047 5)K471 090510 090403 090514 090515 090403 000000 2102227 200 485410  000  00000 6)K321 090510 090514 090514 090515 070128 090403 0353475 100 485410  000  00000 7)R-R  090607 090611 090611 000000 000000 000000 0000000 010 000000  126  31026   _____________________________________________________   P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/29/09  TIME: 12:43:24   PAGE   3          * * *  L A S T   E M P L O Y E R   A D D R E S S E S  * * *            -------------------------:-------------------------:-------------------------  1) 2018695 KANSAS CITY   : 2) 9999999              :  3) 9999999                                        :                         :                           ADT SECURITY             : EMP. RECORD NOT FOUND   :  EMP. RECORD NOT FOUND    7805 NW 97TH TER         :                         :                           KANSAS CITY        MO    :                         :                           64153-   0               :                         :                           -------------------------:-------------------------:-------------------------  4) 2102228 OLATHE KS     : 5) 2102227 OLATHE KS    :  6) 0353475 MARIAM KS                              :                         :  DURHAM D & M LLC         JOHNSON COUNTY TRANSIT   : JOHNSON COUNTY TRANSIT  :  C/O TALX EMPLOYER SVCS L  1701 W 56HWY             : 1701 W 56HWY            :  PO BOX 84                OLATHE             KS    : OLATHE             KS   :  PHOENIX            AZ    66061-   0               : 66061                   :  85001-0084               -------------------------:-------------------------:-------------------------  7) 9999999               :                         :                           DURHAM D & M LLC         :                         :                           EMP. RECORD NOT FOUND    :                         :                                                    :                         :                                                    :                         :                                                     :                         :           Was an employer mailed a 321? If so, what employer received it?    

 P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/29/09  TIME: 12:40:22   PAGE   1 CLAIMANT, WILLETTA R            ON VRU: YES         WITHHOLD: OFF              I 7340 CLEVELAND AVE          EFT-STATUS: 02=OFF EFT          PHONE: 816 337-2256 KANSAS CITY        MO  64132-2017  MOTHER MAIDEN NAME: TAYLOR                   AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   29 RES COUNTY:  095     RES CITY:  0000    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 2--BLACK       ETHNIC: 2-NONHISP  DATE OF BIRTH:  630805 INDUSTRY: 9900  SUB PAY: 000  CLMSRCE: 07  OWNER: 050   DR LIC #: KS K02151986 TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      3110120  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     31101200  NAICS:            812320  TENURE MONTHS:         018 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  GUNN, WILLETTA R          TERM: UPDT  DATE: 07/23/09  TIME: 19:29:42  ADDRESS: 7340 CLEVELAND ST           KANSAS CITY        MO  64127-             * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  070722 070727 070730 070731 070102 070721 2036922 410 561720  337  31037 2)K471 070722 061231 070730 070731 070102 000000 2036920 400 561720  000  00000 3)RED  070722 070727 070731 000000 000000 070721 0000000 400 000000  000  31000 4)R-N  090201 090206 090206 090207 070727 090206 0023509 210 812320  351  31051 5)RED  090201 090206 090209 000000 000000 090206 0000000 200 000000  000  31000 6)R-A  090705 090709 090709 090710 090327 090617 2108553 410 812320  153  31053 ____________________________________________________   P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/29/09  TIME: 12:40:22   PAGE   3          * * *  L A S T   E M P L O Y E R   A D D R E S S E S  * * *            -------------------------:-------------------------:-------------------------  1) 2036922 KANSAS CITY,  : 2) 2036920 KANSAS CITY, :  3) 9999999                                        :                         :                                TROOST CLEANER           : TROOST CLEANER          :  EMP. RECORD NOT FOUND    3339 TROOST              : 3339 TROOST             :                           KANSAS CITY        MO    : KANSAS CITY        MO   :                           64108-   0               : 64108                   :                           -------------------------:-------------------------:-------------------------  4) 0023509 LEEWOOD KS    : 5) 9999999              :  6) 2108553 PLATTE, KS    SCOTCH INDUSTRIES INC    : SCOTCH INDUSTRIES INC   :                                                    : EMP. RECORD NOT FOUND   :  PREMIER CLEANERS         1029 NEW HAMPSHIRE ST    :                         :  1306 PLATTE FALLS RD     LAWRENCE           KS    :                         :  PLATTE             MO    66044-3075               :                         :  00000-3075               -------------------------:-------------------------:-------------------------   Has any employer ever been mailed a 471? If so, what employer received it?

P/N          XXXXXXXXX  BAR INQUIRY  DATE: 07/29/09  TIME: 12:43:24   PAGE   1 DOE, WILLIE A                  ON VRU: YES         WITHHOLD: OFF              P 123 HASKELL AVE             EFT-STATUS: 02=OFF EFT          PHONE: 913 555-5641 KANSAS CITY        KS  66104-0000  MOTHER MAIDEN NAME: HARRIS                  AGENT-STATE: 20 LOCAL OFFICE:  0310  OTHER NAME USED:                          RES STATE:   20 RES COUNTY:  209     RES CITY:  2091    STATUS: 1----ACTIVE    SEX: 2-FEMALE   RACE: 2--BLACK       ETHNIC: 2-NONHISP  DATE OF BIRTH:  731015 INDUSTRY: 9900  SUB PAY: 000  CLMSRCE: 07  OWNER: 050   DR LIC #: KSK123  TYPE WEEK:    0-CALENDAR  WEEK ENDS:   7--SATURDAY  K47/IB14:   0---UNASSIGNED OCCUPATION:      JS70109  EUC OPT: 00  TEU OPT: 00  REDET CODE: 00 DATE:000000 STD OCC CD:     JS070109  NAICS:            485410  TENURE MONTHS:         001 RTW DATE:         000000  EXCESS EARN:      000000  REGISTER:            1-YES OLD BAR  DOE, WILLIE A             TERM: UPDT  DATE: 05/15/09  TIME: 19:29:25  ADDRESS: 3159 ROWLAND AVE            KANSAS CITY        KS  66104-             * * C L A I M S   A C T I V I T Y  - - -  (LAST EMPLOYER ADDRESSES -- L//P) * *     EFFECTIVE  FILED  PROC  MAILED  BEG   LSTDAY SERIAL  RBP  NAICS  EXM  BATCH 1)R-N  061217 061218 070108 070109 061213 061218 2018695 210 564222  126  11026 2)I-N  070617 070617 070619 000000 000000 000000 0000000 000 000000  000  90099 3)I-N  070701 070701 070703 000000 000000 000000 0000000 000 000000  999  90099 4)R-N  090510 090514 090514 090515 090401 090413 2102228 210 485410  347  31047 5)K471 090510 090403 090514 090515 090403 000000 2102227 200 485410  000  00000 6)K321 090510 090514 090514 090515 070128 090403 0353475 100 485410  000  00000 7)R-R  090607 090611 090611 000000 000000 000000 0000000 010 000000  126  31026 What date was used on the 471?  (Format as MM/DD/YYYY)

What information do you receive on a 321?

What information do we get on a 471?