P.O.

Box 9046, Olympia, WA 98507

54000003-000499-01-00000000

Date: Mar 29 2018

Letter ID: L0005087968
CODY S. GRISSOM Claimant ID: TVKK3N
PO BOX 2621 Overpayment balance: $0.00
WESTPORT WA 98595-2621

Monthly Overpayment Statement

Your balance is paid in full. Thank you. Payment due date:
Amount past due: $0.00
Minimum amount due: $0.00

Monthly Transactions Detail

New Overpayment Penalties Interest Accrued Repayment(s) Offset(s) Other

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Previous Statement Balance: $0.00

Current Monthly Transactions: $0.00
Total Amount Owing: $0.00

Cut and return bottom portion with your payment

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Repayment Voucher
Make a payment at https://esd.wa.gov/unemployment/overpayments-new-site or detach this voucher
and mail it back to us with your payment. Include your customer ID number on your payment.
CODY S. GRISSOM Customer ID: TVKK3N
PO BOX 2621 Statement date: Mar 29 2018
WESTPORT WA 98595-2621 Total amount due: $0.00
Send payment and voucher to:
Employment Security Collections
P.O. Box 24928 Amount enclosed: ___________________________________
Seattle, WA 98124-0928 If your address is incorrect,
please check this box q and see reverse.

File your weekly claim, view your unemployment benefit details, find a WorkSource center and more at esd.wa.gov.
Search more than 60,000 Washington jobs on WorkSourceWA.com. Visit WorkSource for free employment workshops and expert
job-hunting advice.

L0005087968
MONTHLY OVERPAYMENT STATEMENT

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 If you fail to repay
If you fail to pay the minimum amount due or the total amount owing, we may
• File a lien in superior court against your real or personal property.
54000003-000499-02-00000000

• Garnish your wages and bank account(s).

We charge interest
• For overpayments not resulting from fraud: If you miss a portion of two minimum monthly
payments, we will charge 1.0 percent interest per month on your balance.
• For overpayments resulting from fraud: We charge 1.0 percent interest each month on your
balance, even if you make your payments on time.

Other ways we may recover payments

Deduct from unemployment benefit payments
The following apply if you are eligible for unemployment insurance benefits.
• If the balance available in your claim is the same as or less than the unpaid balance of your overpayment:
• We will deduct 100 percent of your weekly benefit amount.
• We can’t deduct penalties, interest, or any court costs. You must pay these costs yourself.
• If you miss a portion of two or more payments:
• For overpayments not resulting from fraud: We will deduct 50 percent of your weekly benefit amount.
• For overpayments resulting from fraud: We will deduct 100 percent of your weekly benefit amount.

Deduct money from your federal income-tax refund

Even if you make your payments on time, under certain circumstances, we can still intercept money from
your Internal Revenue Service tax refund.

Get more information

• For questions about what caused the overpayment, call:
Claims Center
Toll free: 800-318-6022
Washington Relay Service: 711
• For questions about repaying us, call:
Employment Security Collections
Toll Free: 866-697-4831
Local: 360-902-9770
Washington Relay Service: 711
Fax: 866-610-9235
Email: bpcunit@esd.wa.gov

My new mailing address is:

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Street address
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City State ZIP code
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Area code Phone number

File your weekly claim, view your unemployment benefit details, find a WorkSource center and more at esd.wa.gov.
Search more than 60,000 Washington jobs on WorkSourceWA.com. Visit WorkSource for free employment workshops and expert
job-hunting advice.

L0005087968
MONTHLY OVERPAYMENT STATEMENT

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