Form Deed-522b - Employer'S Notice Of Change Form - Minnesota Department Of Employment And Economic Development

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EMPLOYER’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.
CHANGE IN BUSINESS ENTITY
COMPLETE ALL APPLICABLE SECTIONS BELOW
3.
CHA
NGED FROM:
CHANGED TO:
!
!
SOLE PROPRIETOR
SOLE PROPRIETOR
!
!
PARTNERSHIP
PARTNERSHIP
!
!
LLC
LLC
!
!
CORPORATION
CORPORATION
!
!
OTHER:
OTHER:
_______________________________________________
______________________________________________
-
FEDERAL I D # (FEIN):
FEDERAL I D # (FEIN):
-
: ___ ___ / ___ ___ / ___ ___
___ ___ / ___ ___ / ___ ___
CHANGED LEGAL ENTITY EFFECTIVE
FIRST MN PAYDAY FOR NEW ENTITY:
% 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-522b

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