Fillable STATE OF CONNECTICUT DEPARTMENT OF LABOR 200 FOLLY (ADP)

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STATE OF CONNECTICUT DEPARTMENT OF LABOR 200 FOLLY (ADP)

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UC-424 (New 12/28/04)
STATE OF CONNECTICUT
DEPARTMENT OF LABOR
200 FOLLY BROOK BOULEVARD, WETHERSFIELD, CT 06109-1114
POWER OF ATTORNEY
Know All Persons by These Presents That having its principal
(Client)
Office at does hereby appoint to
(Place of Business) (Representative)
represent the said company in unemployment tax and claim related matters before the:
Connecticut Department of Labor
200 Folly Bro
ok Boulevard
Wethersfield, CT 06109
Until further notice.
In Witness Whereof I have hereunto signed my name and said company has caused this instrument to be
attested by the signature of its duly qualified officer this day of , .
(Day) (Month) (Year)
This authorization cancels and supersedes all prior authorizations.
By:
Title:
Employer registration number:
Federal ID number:
Dated this day of , .
Before me personally appeared , known to me and made
oath to the truth of the matters contained herein.
Notary Public
Commissioner of Superior Court
CLEAR
PRINT
SAVE
ADP, LLC, and its subsidiaries and Corporate
Cost Control, LLC, to be known as ADP-NH.
____________________________________________
NOTARY IS REQUIRED
THIS MESSAGE WILL NOT PRINT
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STATE OF CONNECTICUT DEPARTMENT OF LABOR 200 FOLLY (ADP)

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Completed 8 February 2021

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