DI / DE 731BF

SAMPLE, this page for reference only.

EDD - PAID FAMILY LEAVE
PO BOX 997017
SACRAMENTO CA 95799-7017
SAMPLE CLIENT
‎1234 ANY STREET
ANY CITY CA 99999-9999

Notice of Replacement of Forged Paid Family Leave (PFL) Check

We are separately sending you a replacement for the Paid Family Leave (PFL) check(s) you certified was (were) forged.

DE 731BF (6-04) (INTRANET)