ID-4E Notice of RUIA Claim Determination

FORM APPROVED
OMB NO. 3220-0171
U. S. Railroad Retirement Board
Office of Programs - Assessment and Training
844 North Rush Street
Chicago, Illinois 60611-2092

FORM ID-4E
(11-05)

DAWN R MILLER
ASSISTANT DIRECTOR PAYROLL ACCOUNTING
ELGTN JOLIET & EASTERN RWY CO.
120'0 PENN AVE, SUITE 300
PITTSBURGH, PA 15222

IN REPLY REFER TO
ER NO. 1309

NOTICE OF RUIA CLAIM DETERMINATIONS
This is notice of the Railroad Retirement Board's determinations on claims
filed for benefits under the Railroad Unemployment Insurance Act. Base year
service and compensation was reported by your company for each of the individuals on this notice. As a base year employer, you have the right to request
reconsideration of any of the determinations on this notice. If you disagree
with any of our determinations and decide to request reconsideration, your request must be in writing and must be received by the RRB within 60 days of the
date of this notice. Mail your request to the RRB office under the column
"Board Office".

SOCIAL SECURITY NO
NAME

CLAIM BEGIN DATE GROSS PAYABLE TYPE INFO PAYROLL ID
CLAIM PROFILE
(CHARGED)
BY
CODES BOARD OFFICE
03-12-08
1111111 1111111

$590 -00
(+590-00)

SI

0000082884

07

CHICAGO IL