Form 46800 - Report Of Inactivation
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1REPORT OF INACTIVATION
State Form 46800 (R3 / 5-06)
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
10 N SENATE AVE RM SE106 INDIANAPOLIS IN 46204-2277
Local: 317-232-7436 Toll Free: 1-800-891-6499 Fax: 317-233-2706
FOR OFFICE USE ONLY
Effective
Date
Please type or print in ink.
Audit
Must be completed and returned within ten (10) days.
Examiner
Date
This form must be filed within 30 days of dissolution or liquidation of business.
Completed
Reference Indiana Code 22-4-32-23(b).
Refund
Requested
Placing an account on `Inactive Status' will not relieve the owner of any debts owed to
the State of Indiana.
FILE
(check one)
This report must be filed if:
You or your business discontinued operations in Indiana.
Your organization is operating without employees in Indiana.
NOTE:
If you have sold, leased, or merged all Indiana assets into another company, you need to complete State Form
46799, `Report of Transfer - Complete Sale.'
(
)
-
Indiana SUTA No.:
FEIN:
Legal Name of Employing Unit
d/b/a
Business Address
City
State
ZIP Code
-
Date of last payroll:
month
day
year
ALL REPORTS AND CONTRIBUTIONS ARE IMMEDIATELY DUE AND PAYABLE UPON CESSATION OR
DISPOSITION OF BUSINESS.
REFERENCE 640 IAC 3-1-6.
If there is a different mailing address from the business address listed above, please indicate:
Current mailing address
City
State
ZIP Code
-
Contact person
(
)
-
Phone No.
Ext.
I certify that the information contained in this notice is true and correct.
(
)
-
Authorized Signature
Phone Number
Date
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