Form L -0740 - Application To Suspend The Filing Of Employer'S Quarterly Contribution Reports
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1Commonwealth of Massachusetts
Massachusetts Department of
Workforce
Division of Unemployment Assistance
Employer Liability
Development
19 Staniford Street, 5
floor
th
Division of Unemployment Assistance
Boston, MA 02114
Application to Suspend the Filing of Employer’s Quarterly Contribution Reports
DUA Employer Number:
Date:
Name:
(617) 626-5050
Address:
Fax #: (617)727-8221
To assist employers in filing quarterly contribution reports, DUA sends pre-printed contribution reports to all employ-
ers on our active file. If you no longer have employees in covered employment in Massachusetts, complete this form
in all details and return to the above address within ten days. If your application is not approved, you will be notified.
If your application is approved, DUA will stop sending quarterly contribution reports, but you will continue to be
subject to the Massachusetts Unemployment Insurance Law and are required to notify this agency immediately
whenever you employ one or more individuals either full or part time.
Office Use Only
______________
A/O
Determined By
Reason #_____________
Enter the last day on which any individual in employment subject to the Massachusetts Unemployment Insur-
A
ance Law (MGL C. 151A) was paid wages by you, whether employed full or part time. (Officers of corpora-
tions are considered employees if compensated.)_________________________________________________
month/day/year
B
This business was sold or transferred:
in whole
in part
on:_________________________to:
month/day/year
Name:_____________________________DUA Employer #_________________________FEIN:_________________
Address:________________________________________________________________________________________
PLEASE NOTE: THE SUCCESSOR EMPLOYER MUST FILE AN EMPLOYER’S STATUS REPORT (DUA Form 1110)
WITHIN 120 DAYS OF TAKING OVER A BUSINESS. TO OBTAIN A FORM, PLEASE CALL (617) 626-5050. THIS
FORM CAN ALSO BE DOwNLOADED AT
C
Reason for filing this application:
Change of ownership
(3) Business permanently discontinued
(4) Operating without employees
(5) No employees in covered employment
(6) No employees in Massachusetts
(7) Bankruptcies, Assignments
(10) Other:_________________________
(11)
D
Do you expect to pay wages in the future?
Yes
No
E
Payroll records will be maintained by:_____________________________, at the following address:
______________________________________________________________________________________________
I hereby certify that the statements made herein are true and correct to the best of my knowledge and belief. THIS
STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY.
_____________________________________
Name of Employer:___________________________________________ By:
______________________________________
____
Telephone Number
Date: ____________________________________
Form L -0740 Rev. 08-06
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