Form Uct-115 12/03 Wisconsin Report Of Business Transfer Page 2
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26. Method of Transfer
Sale
Foreclosure
Reorganization (Change of Legal Form)
Management Contract
Lease
Cancellation of Lease
Merger or Consolidation
Sale of Corporate Stock
Inheritance
Bankruptcy Sale
Receivership
Other__________________
7. Assets Transferred
Real Estate
Machinery & Equipment
Franchises & Licenses
None
Inventories
Furniture & Fixtures
Goodwill
Other__________________
Contracts
Accounts Receivable
Customer Lists
__________________________
8. Continuation of Business
Has the new owner/operator continued to operate the same business activity:
Without interruption?
Yes
No
In the same location?
Yes
No
If either answer is No, explain fully and give address of new location
9. Number of Employees
How many employees worked in the TRANSFERRED BUSINESS
How many employees continued with the new/owner operator?
just prior to transfer?
_____________
____________
10. Identify Nature of Business Transferred
What specific business activity was transferred?
11. Total or Partial Transfer
Total transfer of former owner/operator’s Wisconsin business operations
Will the former owner/operator continue to have payroll or employees after the transfer date?
Yes
No
If Yes, explain why
AND estimate last employment date
Partial transfer of former owner/operator’s Wisconsin business operations
Type of Business Kept by Former Owner/Operator
Trade Name
Number of Employees Kept
Business Location (Street, City, State, Zip Code)
Estimate the percentage of the former owner/operator's defined (taxable)
payroll incurring in the TRANSFERRED portion during the twelve-month
period immediately preceding the transfer.
%
_____________
12. Required Signature
Name of Contact Person
Telephone Number
Submitted on behalf of:
(
)
Signature(s)
Date Signed
Former Owner/Operator
New Owner/Operator
Both
UCT-115 (R. 12/2003)
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