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Application For Voluntary Successorship Form: Transfer Of Substantially All Assets - Ohio Department Of Job And Family Services

OHIO DEPARTMENT OF JOB AND FAMILY SERVICES

P.O. BOX 182404

Columbus, Ohio 43218-2404

(614) 466-2319

FOR 0026

APPLICATION FOR VOLUNTARY SUCCESSORSHIP: TRANSFER OF SUBSTANTIALLY ALL ASSETS

To apply for a voluntary succesorship online, please visit our website at

anytime of the day or night. If

you prefer, you may submit your information by completing this form and we will notify you in writing of the outcome. When completing

this form, please print using block capital letters in black ink. For example:

1 a. Transferee's Employer Name

1 c. Transferee's Telephone Number

1 b. Transferee's Employer Account Number

Note: If you do not have an account number, you must submit a

Report to Determine Liability (JFS 20100) with this application.

1 d. If you have not already submitted a Transfer of Business form (JFS 20101), you must submit one with this application.

2 a. Transferor's Employer Name

2 b. Transferor's Employer Account Number

2 c. Transferor's Telephone Number

2 d. If you have not already submitted a Disposition of Business form (JFS 20110), you must submit one with this application.

3. What was the date of the Transfer?

4 a. Enter the number of individuals employed by the transferor at

4 b. Enter the number of individuals employed by the transferee

the time of transfer.

immediately after the acquistion:

5 a. Provide the monetary value of the total assets of the transferor

5 b. Provide the monetary value of the assets which were acquired

at the time of acquisition (including, but not limited to a

by the transferee at the time of acquisition (including, but not

valuation of real property and personal property consistent

limited to a valuation of real property and personal property

with the most recent valuation for federal tax purposes, and

consistent with the most recent valuation for federal tax

intangible property including the value of accounts receivable,

purposes, and intangible property including the value of

patents, trademarks, and goodwill):

accounts receivable, patents, trademarks, and goodwill):

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JFS 20118 (9/2010)

Application For Voluntary Successorship Form: Transfer Of Substantially All Assets - Ohio Department Of Job And Family Services