Form 518 - Registration For Michigan Taxes - 2003 Page 5
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5Michigan Unemployment Agency
518 Schedule B (Rev. 5-03)
UC Schedule B - Successorship Questionnaire
Issued under authority of the Michigan Employment Security Act of 1936. Filing is mandatory for successors.
Successorship Reporting Requirement. If you acquired any part of the Michigan assets, organization, trade or business of
another employer by purchase, rental, lease, inheritance, merger, foreclosure, gift (or any other form of transfer), you must
provide the following information. If you made multiple acquisitions, you must file a separate UC Schedule B for each
acquisition (photocopies of this form are acceptable).
UC Account Number, if already assigned
Federal Employer Identification Number (required)
PART 1: FORMER OWNER INFORMATION
1. Former Owner's Name
2. Former Owner's UC Number or FEIN, if known.
Corporate Name or DBA
3. Area Code & Telephone Number
Current Street Address (not a P.O. Box)
City, State, ZIP
PART 2: ACQUISITION INFORMATION
What Percent?
Date Acquired
1. Did you acquire all, part or none of the former
%
All
None
owner's assets?
Part
2. Did you acquire all, part or none of the former
owner's organization (employee,
All
Part
None
payroll/personnel)
3. Did you acquire all, part or none of the former
All
owner's Michigan trade (customers/accounts)?
Part
None
4. Did you acquire all, part or none of the former
owner's Michigan business (products/services)?
All
Part
None
5. Was the Michigan business being operated at the
time of acquisition? If no, enter the date it was
Yes
closed by the former owner.
No
Month
Day
Year
Are you conducting the Michigan business
6.
Yes
you acquired?
No
Is your Michigan business substantially owned or
7.
controlled in any way by the same interests that
Yes
owned or controlled the former business?
No
8. Did you hold any secured interest in any of the
Yes
Michigan assets acquired?
No
If yes, enter the balance owed $
9. What was the reasonable value of the Michigan
organization, trade, business or assets acquired?
$
Print Name of Owner/Officer
Title
Signature of Owner/Officer
Telephone Number
Date
Attach this schedule to Form 518, Registration for Michigan Taxes and mail it to the Michigan Department of Treasury.
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