Form Uc-517 - Authorization To Change Address Form - Arizona Department Of Economic Security

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Form UC-517
Authorization to Change Address Form
Use this form to change the business’ legal mailing address, the business headquarters’
address and/or the address where the benefit Notice to Employer (Form UB-110) is to be
mailed. An owner, partner, or a corporate officer must sign the form authorizing the change.
(
)
USE THE REPORT OF CHANGES FORM
CHNG
TO ADVISE THE ARIZONA DEPARTMENT OF
.
ECONOMIC SECURITY OF ANY MODIFICATIONS TO YOUR BUSINESS STRUCTURE
—
,
,
,
.
FOR EXAMPLE
CHANGES IN OWNERSHIP
LEGAL FORM
OPERATION
OR PAYROLL METHOD
Questions about completing the Authorization to Change Address Form may be directed to the
Employer Status Unit at
Employer Status Unit
ADES – UI Tax Section – 911B
P.O. Box 6028
Phoenix, AZ 85005-6028
Telephone - (602) 248-9396
771-6602
FAX - (602) 650-1298
532-5539

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