Form Uia 1027 - Business Transferor'S Notice To Transferee Of Unemployment Tax Liability And Rate Page 2

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UIA 1027

(Rev. 5-11) Reverse Side

Calendar

Year

20___

Unemployment Tax Rates

(Solvency Rate)

Non Reporting Penalty

TOTAL

$ 0.00

(e) the Actual Reserve as of the most recent past June 30;

(f ) the Required Reserve as of the most recent past June 30;

(g) the Total Payroll for the 12 months ending the most recent past June 30.

CERTIFICATION: I certify that the information contained on this form is accurate and complete to the best of my knowledge and belief. I understand that criminal and civil

penalties may apply for failure to provide accurate information on this form.

The person signing this form below is the:

Business Transferor;

Transferor’s Real Estate Broker;

Agent of Transferor;

Attorney for Transferor.

Name of Business: __________________________________________________________________________

UIA Employer Account No.: _________________________

Signature: _____________________________________________

Date: ____________________________

Telephone: ______________________________________

Typed or Printed Name of Signer: _________________________________________________________________________________________________________________

Title of Signer: _________________________________________________________________________________________________________________________________

NOTE TO TRANSFEREE: The information on this form may be up to 90 days old. Inquire from the Transferor as to updated information.

CERTIFICATION OF RECEIPT OF INFORMATION BY PROSPECTIVE TRANSFEREE

Name: _____________________________________________________________________________________________

Date: __________________________________

Signature: ________________________________________________________________________

Telephone:

__________________________________________

PROCEDURE FOR CALCULATING UNEMPLOYMENT TAX RATE

A tax rate is composed of the Chargeable Benefits Component (CBC), the Account Building Component (ABC), and the Nonchargeable Benefits Component (NBC). The

method of calculating a rate is shown below.

Years of Contribution Liability

Contribution Rate

2.7%

1/3 CBC plus 1.8% (maximum rate 3.9%)

2/3 CBC plus 1.0% (maximum rate 5.2%)

CBC plus ABC plus NBC

Construction employers have higher minimum rates for the first four years of liability.

All rates are figured using the following calculations as provided by Section 19(a)(1) of the Act.

Chargeable Benefits Component (CBC):

Account Building Component (ABC):

60 months of benefit charges

(Required Reserve minus Actual Reserve) X 0.50= ABC

The Calculation is:

= CBC

The Calculation is:

60 months of taxable payroll

12 months of total payroll

The result is rounded up to the next higher 0.1%.

The maximum value is 6.3%.

The maximum value for the ABC is 3.0%.

Nonchargeable Benefits Component (NBC): If there were Benefit Charges in any of the 5 years shown in Section 5(b) of this form, the NBC is 1.0%. If the CBC was equal to 0.1%,

the NBC is 0.5%. If there were no Benefit Charges for those 5 years, the NBC is 0.1%. If there were no Benefit Charges for more than 5 years, the NBC may be as low as 0.06%.

Solvency Tax Rate: When the UI Trust Fund has interest-bearing advances from the federal government, a Solvency Tax becomes effective. This tax is levied against all fully

experienced employers with a negative (Actual Reserve) balance. Solvency Tax monies are not credited to the employer’s experience account. The Solvency Tax, if applicable,

shall be computed in accordance with the provisions of Section 19a(2)(e) of the MES Act.

Total Tax Rate: The total rate is calculated by adding the three tax components (CBC + ABC + NBC) and state tax penalties.

Non Reporting Penalty: If any or all quarterly tax reports used in the computation of a tax rate are missing, an additional non-reporting penalty of 2% to 3%, per House Bill

4804 enacted 12/31/93, is added to the Total Tax Rate.

SUTA Rate Penalty: As Required by Public Act No. 18 of 2005, a SUTA Rate Penalty has been added to your computed rate because it has been determined that you knowingly

violated or attempted to violate Section 22b(1) of the MES Act.

IF YOU NEED ASSISTANCE IN COMPLETING THIS FORM, YOU MAY CALL THE UIA TAX OFFICE AT (313) 456-2180.

THIS FORM MUST BE PROVIDED TO PROSPECTIVE PURCHASERS.