Form C-36 - Notice Of Change 2010

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Telephone: (802) 828-4344
VERMONT DEPARTMENT OF LABOR
VERMONT EMPLOYER NO.
Fax: (802) 828-4248
ATTN: EMPLOYER SERVICES, P.O. Box 488
Montpelier, Vermont 05601-0488
NOTICE OF CHANGE
C-36 (12/10)
Complete all items applicable to your organization, trade, business or employment in Vermont.
Nature of Change:
Change of Address/Trade Name > Complete Part A, D & E
Ceased Employment > Complete Part B, D & E
Sale/Lease/Reorganization of Business > Complete Part C, D, & E
CHANGE OF ADDRESS/TRADING AS: Corrections to Name and/or Address of record. (NO CHANGE IN OWNERSHIP OR BUSINESS TYPE)
Name: ____________________________________________________ Contact: ____________________________________________________
A
Trading As: ________________________________________________
Telephone: _________________________________________________
Address: __________________________________________________
Fax & Email: ________________________________________________
CEASED EMPLOYMENT
Date Employment Ended: ____________________
Final Pay Date: ____________________
No Longer have Vermont Employees
Explain: __________________________________________________________________
Discontinued operations in Vermont
Explain: __________________________________________________________________
B
Out of Business - Reason:
Ceased Business / Closed
Filed for Bankruptcy
Foreclosure
Location of all employment records:
Address: ___________________________________________________________________________________________________________
Contact: ________________________________
Telephone: _________________________
Fax: _____________________________
Email Address: ____________________________________
If your business is a Corporation, are your officers receiving any wages or draws after the effective date?
Yes
No
SALE / LEASE / REORGANIZATION OF BUSINESS (PLEASE PROVIDE THE FOLLOWING INFORMATION)
1. Date of Change
_____________________
2. Date Final Wages Paid
_____________________
3. Nature of change:
ALL of Vermont Business Sold
PART of Vermont Business Sold
ALL of Vermont Business Leased
PART of Vermont Business Leased
Reorganization of Business
4. Did you retain title or control of any assets?
No
Yes - If "Yes"
ALL
PART (Specify percentages below)
MACHINERY
LAND
VEHICLES
OFFICE
FURNITURE
BUILDINGS
INVENTORY
ACCOUNTS
FRANCHISE
OTHER-SPECIFY
EQUIPMENT
& FIXTURES
TYPE & PERCENTAGE
RECEIVABLE
ON ATTACHED SHEET.
C
5. Other Assets retained: _________________________________________________________________ Percentage Retained: _______%
6. Enter the complete name, trading as, address and telephone number of the new owners/operators of the business:
Legal Business Name ___________________________________________________________________________________________
Trading As ____________________________________________________________________________________________________
Mailing Address ________________________________________________________________________________________________
City, State, Zip _________________________________________________________________________________________________
Contact: _______________________ Telephone Number: _____________________ Email Address: ____________________________
7. Is there any common ownership between the two businesses?
Yes
No
If Yes, attach explanation
SECTION C CONTINUED ON PAGE 2

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