W****D***E**********G

The deposit amount shown on this stub should be accessible through your debit card within 2 working days beyond the date shown. Verify funds have been deposited into your account prior to using.

- CONTINUED ON NEXT PAGE -

Si usted no puede leer esto, llame por favor a 1-877-***-**** para una traduccion. CREDIT FROM THE UNEMPLOYMENT COMPENSATION BENEFIT ACCOUNT Three Hundred and 00/100 Dollars

300.00

25-174

440

FUND

29

DATE DEBIT TRANS. NO.

95

ADVICE OF DEPOSIT ONLY NON-NEGOTIABLE

OFFICE OF UNEMPLOYMENT COMPENSATION

TO THE

ACCOUNT

OF

NON-NEGOTIABLE

03/04/2021 063********

MICHAEL E. VON DRISKA

218 1/2 WHITETHORNE AVE

COLUMBUS, OH 43223-1132

OHIO DEPARTMENT OF JOB AND FAMILY SERVICES

OFFICE OF UNEMPLOYMENT INSURANCE OPERATIONS

BENEFIT PAYMENT INFORMATION

JFS-81110 11/10/2016

Claimant's Name

MICHAEL E. VON DRISKA

Claimant ID

214845990

Social Security Number

***-**-****

Date

03/04/2021 063********

Debit Transaction Number Total Remaining Benefits

$0.00 300.00

Amount Deposited

EACH ITEM BELOW APPLIES TO YOUR CLAIM - MAINTAIN THIS STUB AS YOUR RECORD OF PAYMENT WEEK

ENDING

FED

ADDL

COMP

EARNINGS INCOME

GROSS

AMOUNT

PAYABLE

OVER-

PAYMENT

OFFSET

CHILD

SUPPORT

FEDERAL

TAX

NET

PAYABLE

AMOUNT

02/20/2021 $300.00 $0.00 $0.00 $300.00 $0.00 $0.00 $0.00 $300.00 W1012D062E0160762020G

WHEN FILING A CLAIM FOR A WEEK OF UNEMPLOYMENT, ALWAYS REPORT THE GROSS EARNINGS (BEFORE ANY DEDUCTIONS) FOR ALL WORK PERFORMED DURING THE WEEK

(REGARDLESS OF WHEN YOU ARE PAID). REPORT ALL OFFERS OF WORK ANY ILLNESS OR DISABILITY THAT WOULD PREVENT YOU FROM WORKING, AND ANY APPLICATION FOR OR RECEIPT OF WORKERS COMPENSATION.

Contact this candidate