Form Deed-522c - Employer'S Notice Of Change
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1EMPLOYER’S NOTICE OF CHANGE
MINNESOTA DEPARTMENT OF EMPLOYMENT and ECONOMIC DEVELOPMENT - UI EMPLOYER ACCOUNTS OFFICE
390 ROBERT ST N
ST PAUL MN
55101-1812
TELEPHONE: (651) 296-6141
FAX: (651) 297-5283
TDD/TTY: (651) 282-5909
INTERNET:
-
E-MAIL: deed.tax.liability@state.mn.us
-
UI EMPLOYER ACCOUNT NUMBER:
Please enter your current business name and address here:
ENTER CURRENT NAME, COMPLETE MAILING ADDRESS AND UI EMPLOYER ACCOUNT NUMBER ABOVE.
C.
A
CQUISITION / SALE / OTHER DISPOSITION OF BUSINESS
COMPLETE
T
HOSE
SEC
TIONS
W
HICH APPLY
CORPORATE MERGER OR CONSOLIDATION
TRANSFER OF CORPORATE STOCK WITHOUT FORMATION OF
1.
2.
EFFECTIVE: ___ ___ / ___ ___ / ___ ___
A NEW CORPORATION EFFECTIVE: ___ ___ / ___ ___ / ___ ___
SURVIVING ENTITY:______________________________
ATTACH UPDATED OWNERSHIP INFORMATION AND PROVIDE
FEDERAL I D # (FEIN)OF SURVIVOR:
FEDERAL I D #:
-
-
IF BUSINESS WAS SOLD, PROVIDE BUSINESS NAME, COMPLETE
SOLD
ALL
PART
OF BUSINESS
3.
MAILING ADDRESS & PHONE # OF NEW OWNER:
OPERATIONS IN MINNESOTA
EFFECTIVE: ___ ___ / ___ ___ / ___ ___
DATE OF LAST MN PAYDAY: ___ ___ / ___ ___ / ___ ___
IF BUSINESS WAS ACQUIRED, PROVIDE PREVIOUS OWNER’S
ACQUIRED (PURCHASED, LEASED OR ASSUMED)
4.
BUSINESS NAME, COMPLETE MAILING ADDRESS & PHONE #:
ALL
PART
OF AN EXISTING MINNESOTA
BUSINESS
EFFECTIVE: ___ ___ / ___ ___ / ___ ___
IS PREVIOUS OWNER (PREDECESSOR) STILL DOING
BUSINESS IN MINNESOTA?
NO
YES
UNKNOWN
5. IS THERE 25% OR MORE COMMON OWNERSHIP BETWEEN THE CURRENT AND PREVIOUS BUSINESS?
NO
YES
(IF YES, COMPLETE 6.)
IF YOU ANSWERED YES TO 5, AND ACQUIRED ONLY A PART OF THE PREVIOUS BUSINESS, DO YOU WISH TO APPLY FOR
THAT PORTION OF THE PREVIOUS EMPLOYMENT EXPERIENCE BY PROVIDING PAYROLL INFORMATION?
NO
YES
6
% OWNED
NEW OWNERS OR OFFICERS
% OWNED
RELATIONSHIP
.PREVIOUS OWNERS OR OFFICERS
(predecessor)
(successor):
(successor)
(predecessor):
THIS INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
PREPARER-SIGNATURE:
TITLE:
DATE:
PHONE:
DEED-522c
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Parent category: Business