Attachment C
To UIPL3-91

Facsimile - Formal Letter Requesting Voluntary Repayment of Title XII Advances

The Honorable Elizabeth H. Dole
Secretary of Labor
U.S. Department of Labor
Room S-2523
200 Constitution Avenue, N.W.
Washington, D.C. 20210

Dear Secretary Dole:

In accordance with the provisions of Section 1202(a) of the Social Security Act, I hereby request the transfer of $___________ from the account of the State of __________________ in the Unemployment Trust Fund to the Federal unemployment account, to be effective on ______________________________________.

This requested transfer of funds represents voluntary repayment (in full or partial repayment) of repayable Title XII advances made to the State of _________________________ during the period ______________________.

Sincerely,