Form K-Cns 0103 - Employer Account Record Change
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3KANSAS DEPARTMENT OF LABOR
Page 1 of 3
EMPLOYER ACCOUNT RECORD CHANGE
SUBMIT
K-CNS 0103 (Rev. 10-13)
ONLINE:
MAIL:
Kansas Department of Labor
PO Box 400
Topeka, KS 66601-0400
(SEE INSTRUCTIONS ON PAGE 3)
FAX:
(785) 291-3425
1. Employer Serial Number:
2. Date of change (mm/dd/yyyy):
3. Federal Employer Identification Number (FEIN): Is this a change? YES NO
4. Legal business name:
5. Business trade name:
6. Mailing address:
Street or PO Box:
City:
State:
ZIP:
(
)
Phone:
7. Business address in Kansas:
Street or PO Box:
City:
State:
ZIP:
(
)
Phone:
8. Reason for change (use a separate form K-CNS 0103 for each successor):
A.
Business in Kansas continues in operation without employment
B.
Business in Kansas suspends or entirely discontinued without successor
C.
Business in Kansas acquired by successor
Date acquired (mm/dd/yyyy): Entirely (100%) Partial (less than 100%)
Substantially all of the assets: YES NO
(If #8 is completed for
Substantially all of the employing enterprise, organization, trade or business: YES NO
successorship, complete
items #9 and #10)
9. Successor information:
Trade name:
Owner/principal:
Street or PO Box:
City:
State:
ZIP:
(
)
Employer Serial Number (if available):
Phone:
Please transfer the previous owner’s experience rating factors as provided in K.S.A. 44-710a(b)(2): YES NO
UNEMPLOYMENT TAX CONTRIBUTIONS
PO Box 400, Topeka, KS 66601-0400 • Phone (785) 296-5027 • Fax (785) 291-3425
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