UI / DE 120A

SAMPLE, this page for reference only.

The Great Seal of The State of California
Date:
Case #:

Dear:

This is in response to your telephone call/correspondence of Blank line

This office has taken the following action:

 
Department Representative
Centralized Overpayment Establishment Group
1-866-401-2849
P.O. Box 2228
Rancho Cordova, CA 95741-2228
DE 120A Rev. 6 (3-18)