Form Es-802 O - New Mexico Department Of Workforce Solutions printable pdf download

NEW MEXICO DEPARTMENT OF WORKFORCE SOLUTIONS

PO Box 2281, Albuquerque, New Mexico 87103 * (505) 841-8570

EMPLOYER:____________________________________ ACCOUNT #______________

ADDRESS: __________________________

CITY, ST ZIP:________________________

BANK:_________________________________

CERTIFICATE NO._____________

ADDRESS: ______________________________

CERTIFICATE AMT.____________

CITY, ST ZIP:____________________________

MATURITY DATE:_____________

In consideration of Section 51-1-13 NMSA 1978 of the New Mexico Unemployment

Compensation Law, hereby assigns all rights, interest, and title to the Certificate of

Deposit described above, over to the New Mexico Department of Workforce Solutions.

Earned interest shall be paid directly to employer, however, the Department is entitled

to negotiate this instrument, or any portion thereof, in the event employer fails to pay

the required reimbursable benefit charges, when due. The Department shall retain

possession of the Certificate of Deposit and shall return the Certificate and any interest

earned to the employer upon termination of employer's unemployment compensation

obligations in New Mexico, provided that all required reports have been submitted an all

reimbursable benefit charges due and potential benefit charges as determined by the

Department have been paid. In the event the employer fails to pay reimbursable benefit

charges due, the Department has the right to retain the entire Certificate of Deposit in

full or partial payment of the reimbursable benefit charges due. This assignment will

remain in effect until the Maturity Date of the Certificate of Deposit described above or

upon a mutual release by the Department and the employer prior to the maturity Date.

The bank is hereby authorized to pay over the proceeds of the Certificate of Deposit to

the Department upon presentment and the employer hereby waives any and all claims

against the bank for doing so. The bank and the employer waive the right to enforce any

"Non Transferable" language on the face of the Certificate of Deposit and acknowledge

that the New Mexico Department of Workforce Solutions will have all of the rights to the

Certificate of Deposit of a secured party under New Mexico Law. The bank hereby agrees

not to release any of the principal amounts to the employer, without the prior approval

by the New Mexico Department of Workforce Solutions.

_______________________________

_____________________________

Employer Representative, Title

Bank Representative, Title

Subscribed and sworn before me this _____day of __________________, 20___.

Notary Public: ___________________________________

My Commission Expires ___________________________

ES-802 O (B)

Rev. 07/07

S/N

Form Es-802 O - New Mexico Department Of Workforce Solutions