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


PO Box 2281, Albuquerque, New Mexico 87103 * (505) 841-8570
EMPLOYER:____________________________________ ACCOUNT #______________
ADDRESS: __________________________
CITY, ST ZIP:________________________
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


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Parent category: Financial