WOTC Instructions

Based on the answers provided during the WOTC Tax Credit Survey,
the candidate listed may qualify the company for certain tax credit
program(s).

Please complete the action items listed below.

Octavio Guzman
Candidate Name:__________________________________________________

This candidate is potentially Eligible.

ACTION ITEMS
1. The following documents are required. Have the candidate complete and sign them:
1. Driver's License

2. If directed to supply documents in Step 1, then immediately provide them to Ernst

& Young using one of the methods below.

Mail or Fax to:

Ernst & Young Fax # 1 (800) 929-0989

Attn: WOTC Processing Center Phone # 1 (800) 524-4414
P.O. Box 226896 NOTE: Protect personal information.
Dallas, TX 75222 If faxing, ALWAYS use this page as
the fax cover sheet.

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Drivers License Request
Based on the answers provided during the Work Opportunity Tax Credit Survey, the applicant/new hire
lists may qualify the company for certain tax credit program(s) and a copy of their drivers license/state
ID is required. It is used for applicant/new hire verification of address and/or date of birth.

Please complete the items listed below.

Applicant/New Hire Name:___________________________________________________________

Confirmation Number:_______________________________________________________________
14954328152

This applicant/new hire is potentially Eligible.

Action Items
1. Copy the applicant/new hires drivers license/state ID or passport
2. Mail OR fax the drivers license/state ID or passport to EY today

Tips for Faxing:

Enlarge the document before faxing
Copy on a lighter setting
Review the copy to ensure it is readable before faxing
Always add the employee confirmation number to the copy (found above)

Use one of the following methods to submit required document indicated above to EY:

Fax Number OR Mailing Address

1 800 929 0989 EY
Attn: WOTC Operations Center
P.O. Box 226896
Dallas, TX 75222

To help expedite processing of forms, please choose only one method to submit forms to EY.

14954328152
Confirmation # XXX
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Revised 5/2016