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PAGE 1
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rKEEP THIS STATET-IENT
FoR yoUR RECoRDS.
DATE ISSUED O8/11/Og
'SSN:
575-13-21 19
NAlrlE: DANIEL K KAUWE
CLAIM EFFECTM DATE: 1O/13/O8
WEEKLY RATE: $471.OO
WEEKLY RATE IS FOR 7 DAYS
EXCEPT FOR THE I,IANDATORY 7-3AY WAITING PERIOD, YOU WILL BE PAID FOR EVERY DAY YOU ARE ELIGIBLE FOR
BENEFITS, INCLUDING }IEEKENDS.
IF YOU ARE NOT PAID FOR ANY DAYS, YOU WILL BE NOTIFIED I{HAT DAYS t,lERE NOT PAID AND WHY THEY WERE NOT PAID
IN THE ITESSAGE AREA BELOW. THE OFFICE PROCESSING YOUR CLAI}I IS:
EI{PLOYIttENT DEVELOPI,IENT DEPARTI,IENT
TELEPHONE: (800) 480-3287
P0 Box 10402
vAN NUYS CA
91410-0402
THE ATTACHED CHECK IS FOR STATE IIISABILITY
I]{SURAI{GE FOR THE FOLLO}|I]|G PERI0D(Sl2 o7/27/09
THROUGH O8/O9/o9.
TIO. OF DAYS
BE]IEFIT Af,T.
AIT. DEDUCTED
A}tT. PAID
t4
$942.00
$0.00
$9+2.00
ITESSAGE-AREA
IllPORTAltlT NOTICE:
rF you Do Nor UNDERSTAND ANy FoRtq SENT To you By rHIs oFFIcE, coNTAcr us FoR
ASSISTANCE AT THE TELEPHONE NUI4BER SHOI.'N ON THE CHECK STATEIJIENT.
DE 2500CKX Rev. (8/03)
DETACH THIS STUB FOR YOUF RECOBDS/REMUEVA
ESTE TALON PAFA SU BECOFD PERSONAL
au-PAu61 Rev.1 (/-07) FLASFI
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PLEASE DISREGARII THE FORII Oil THE BAGK OF THIS STUE - ItO lrloT RETURII
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Irrlp TTITs STATEI,IENT
FoR YOUR REcORDS.
DATE ISSUED 10/06/09
SSN:
575-13-2719
NAI4E: DANIEL K KAUWE
CLAIM EFFECTIVE DATE: 1O/13/O8
I.TEEKLY RATE: $471.OO
I{EEKLY RATE IS FOR 7 DAYS
EXCEPT FOR THE ITIANDATORY
7-DAY WAITING PERIOD, YOU WILL 3E PAID FOR EVERY DAY YOU ARE ELIGIBLE FOR
BENEFITS, INCLUDING WEEKENDS.
IF YOU ARE NOT PAID FOR ANY DAYS, YOU WILL BE NOTIFIED I.IHAT DAYS WERE NOT PAID AND WHY T