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Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}% 5InputuInput ̙ ??v% 6 Linked CellK Linked Cell }% 7NeutralANeutral  e%"Normal 8Noteb Note   9OutputwOutput  ???%????????? ???:$Percent ;Title1Title I}% <TotalMTotal %OO= Warning Text? Warning Text %XTableStyleMedium9PivotStyleLight16`67 Request Formd Instructions  ;2 !Date Received in Central Payroll:Date Prepared:Requestor's Name/Contact #:City: Street: Apartment:State: Zip Code:Steps:86. The final two lines will be used by Central Payroll.Purpose:The purpose of the form is to have documentation on who sent the form, why they sent it and what corrections should be made. It is a beneficial document to make corrections quick and easy and it will be beneficial if the form is reviewed in later years. Other:It doesn't matter if this form is typed up on-line and then printed or printed off and filled in by hand. Just make sure it is legible.8REASON (and necessary adjustments) for 1099R correction:Date of Correction:3. Explain the reason for the adjustment. Show the adjustment(s) that should be made. Also attach any necessary documents as backup. A copy of an email works too.s5. Please provide your name and contact number in case the person preparing the correction has any questions.C2. Enter the social security number and the emplid of the retiree.WThe 1099-R Correction Request Form is to accompany all requests for 1099-R corrections.@1. Enter the name of the retiree needing the 1099-R correction.4. Fill in the address in which to send the 1099-R correction if it is different than the address on the original 1099-R. The address on the 1099-R correction will remain as the original address because the change is not required by the IRS.1099-R Correction Request FormName on 1099-R:GAddress to send 1099-R correction to if different than original 1099-R:Emplid:Tax YearCentral Payroll Use Only;Please attach a copy of the original 1099R to this request.Modified 4/5/2011 MB"/ u025ccB  3V^b  dMbP?_*+%&(\?')\(?(?)Q?M\\um-ics-printers\UM/UniversitS odXXLetterPRIV0'''' \KhC`m6SMTJHP Universal Printing PSHPDocUISUITrueESPRITSupportedTrueHPOrientationHPOrientationPortraitHPOrientRotate180FalsePostScriptCustomPageSizeFalseDuplexDuplexNoTumbleHPReverseOrderForFold_StitchTrueHPBestGlossDefaultInputSlot*UseFormTrayTableHPDuplicateJobNameOverrideSWFWPageSizeLETTERPageRegionLeadingEdgeMediaTypeAutoHPMediaTypeTreeviewPopupTrueCollateFalseJCLHPPrintOnBothSidesManuallyFalseJCLEconomodeFalseOutputBinAutoStapleLocationNoneTextAsBlackFalseJCLResolution600dpiJCLFastRes1bppHPConsumerCustomPaperTruePrintQualityGroupPQGroup_2JRHDInstalledJRHDOffHPNUseDiffFirstPageChoiceTrueHPPageExceptionsFileHPCPE081HPPageExceptionsInterfaceShowPageExceptionsHPPageExceptionsLowEndHPPageExceptionsLowEndVerHPPageExceptionsCoverInsertionHPEnableRAWSpoolingTrueHPDocPropResourceDataHPCabFileNameRGBColorDefault-sRGBCMYKInksNoCmdJRConstraintsJRCHDFullHPColorSmartAutomaticHPColorSmart_ColorOptions_EdgeControlNormalHPColorSmart_ColorOptions_RGBColorDefault(sRGB)HPColorSmart_ColorOptions_HalftonDetailHPColorModeCOLOR_MODEHPColorSmart_Text_NeutralGraysBlackOnlyHPColorSmart_Text_HalftoneDetailHPColorSmart_Graphics_NeutralGraysBlackOnlyHPColorSmart_Graphics_HalftoneDetailHPColorSmart_Photo_NeutralGrays4-ColorHPColorSmart_Photo_HalftoneDetailHPPJLEncodingUTF8HPJobAccountingHPJOBACCT_JOBACNT_GROUPNAMEHPBornOnDateHPBODHPXMLFileUsedhpcu081s.xmlPSAlignmentFileHPCLS081HPSmartHubInet_SID_263_BID_514_HID_265HPColorAsGrayFalseIUPHxMOA&ƈ"ތI/z+CXYځ6RY[HK,Vx׏G^M$ܼEt. &,jj7pf$͊H83d O3^KccX8k^c,ƹ,2ɢO/A8>uA5 zyh ϖdɬUV,#_6geƌQ3&ݥnb&ΠƷL4c}m qsfJ%"XW-fKu5CR̳)˚֪QDZs팰=5ܐi>-/m /5?7wE3Uzz|hv)LqW<3nt[DlȾwl[tE&jGM(?=z7$Džaj>P !IQQQQQQQQQR "I"oooo "H"> "J "oor #IJJJJJJJJJK $UVVVVVVVVVW %IJJJJJJJJJK &_&``oooooo\R 'IJJJJJJJJJK (I(J^^GQQQQQR )IJJJJJJJJJK *IJJJJJJJJJK +s+tttttttttu ,IJJJJJJJJJK -IJJJJJJJJJK ._.```ppLJJJK /IJJJJJJJJJK 0_0`^^JJJJJJK 1IJJJJJJJJJK 2v2SSSSSSSSST *|hB V , , , , , ><dSR   &&..((  """" ++ 00&&..00 7ggD  Dln  dMbP?_*+%&C&"Arial,Bold"&14&F - &A"&C&"Arial,Bold"&12Page &P of &N&?'zG?(?)?MLexmark Optra E312 PS2 odXLetter 8 1/2 x 11 in'@'''',,<-XX<-XX<-(None)(None)(None)(None)& <'"dX??&U} UX9@     X Y Y Y Y X X Y Y Y Y Y Y >@YZ7ggD  Oh+'0HP`t dewsd bishopdmMicrosoft Excel@@1m@՜.+,00 PX   ǿմý System  Request Form Instructions'Request Form'!Print_Area  Worksheets Named Ranges F&Microsoft Office Excel 2003 WorksheetBiff8Excel.Sheet.89qCompObj r