Form UC-10-C                                                                  Account  __________________________________                      
(REV.    12-00) 
                                         STATEMENT TO CORRECT INFORMATION 
                        PREVIOUSLY REPORTED UNDER THE ALABAMA UNEMPLOYMENT COMPENSATION LAW         
     
      Type or print the name, address and account number in this                       STATE OF ALABAMA 
     space as it appears on your wage report.                                          DEPARTMENT OF LABOR 
                                                                             UNEMPLOYMENT COMPENSATION AGENCY 
                                                                              MONTGOMERY, ALABAMA 36131 
                                                                              Indicate the type wage report being corrected. 
                                                                              UC CR-4              UC-10-R             
                                                                 If the social security number, name or wage of one or more workers was 
                                                                 omitted from or erroneously reported on one or more returns, each such error 
                                                                 should be corrected on this form. 

  WORKERS SOCIAL    NAME OF WORKER  QTR1.2.3 0R4     Correct Total Wages     Total wages as        Correct Taxable     Taxable wages as 
  SECURITY NUMBER   (TYPE OR PRINT) QTR.      Yr.                             reported             Wages                     reported 
                                                                                                                    
                                         Totals                                                                                                   
                    Increase+/Decrease        < >                                                                                                 
     REMARKS 

     DATE                                     Signature and Title

                                              PLEASE DO NOT WRITE BELOW THIS LINE 
     AUDITOR:       ___________________________________________________       DATE __________________________________ 
     KEYED BY:      ___________________________________________________       DATE __________________________________ 
     VERIFIED BY:   ___________________________________________________       DATE __________________________________ 
                                                                             
      TT          RCVD DATE                    REMITTANCE                                       ACCOUNT NUMBER 

      WC                                                                                             

     Q/YR         RATES     TOTAL WAGES              EXCESS WAGES             TAXABLE WAGES                        PAYMENT 
                 ER  ESA