Form 60-0111 - Employer'S Notice Of Change
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1Account Number
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Variable
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Form Number
Variable No.
Auditor Initials
Date
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60-0111
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Description (limit of 35 characters)
Account No.
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Tax Section, U.I.S. Division
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
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IOWA UI Account Number
EMPLOYER'S NOTICE OF CHANGE
60-0111 (5/08)
Use this document to record a change of address, change of name, change of telephone number, addition or change of Federal ID
Number, change of account status, cessation of business or sale of a portion or all of the Iowa business. If not preprinted, provide
your employer name and account number. Complete all sections that apply, then date and sign below. Attach any documentation
you feel is necessary.
Employer Name:
Business Name
Street Address/PO
City, ST ZIP
CHANGE IN NAME, ADDRESS AND/OR FEDERAL IDENTIFICATION NUMBER:
Mark appropriate choice and provide additional information requested.
X
Effective date of change:
Mailing address changed to:
Legal name changed to:
Tradename OR In Care Of
Street/PO
Business name changed to:
City,ST,ZIP
Telephone No. changed to:
Location address changed to:
St/PO
If federal IRS/employer identification (FEIN) has
City,St,ZIP
changed for any reason, complete "Change in
Additional Iowa location(s) add
ed. Attach list providing full name
and address of each location.
Ownership" section below or attach a letter.
REQUEST ACCOUNT BE PLACED IN INACTIVE STATUS:
Mark appropriate choice and provide any dates requested.
NOTE that this response pertains to Iowa business activity only.
BANKRUPTCY INFORMATION:
Closed business. Date last wages paid:
Bankruptcy Petition #
Chapter #
Judicial District
(Note:If sold or transferred, complete "Change in Ownership"
section below.)
Petition date
Attorney telephone number (including area code)
Operating without employees in Iowa.
Date last wages paid:
Attorney name
NOTE: Corporate officer salaries ARE wages and ARE taxable.
Firm name
Discontinued household/domestic employment
Street/PO
Date last wages paid:
City,ST,ZIP
CHANGE IN OWNERSHIP - INCLUDES SALE, MERGER, TRANSFER, LEASE:
Mark appropriate choice and provide additional information requested. Provide future address in "Change in Name...." section.
Sold, merged, leased or transferred PART of Iowa business.
Date of transfer
Prior owner's last day of payroll
Sold, merged, leased or transferred ALL of Iowa business.
Portion of Iowa business sold, merged, leased or transferred:
New owner's name & address
(Identify location(s) and primary assets transferred.)
Owner
Street /PO
City,ST, ZIP
Prior owner retains some Iowa business
New owner contact person
Buyer telephone number
which continues to generate Iowa payroll?
Yes
No
I hereby certify
that the information in this notice is complete and correct. If my account is in an inactive status, I understand and agree
to notify Iowa Workforce Development immediately if employment in Iowa is resumed.
Signature
Title
Tele
Date
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request for individuals with disabilities. For deaf and hard of hearing, use Relay 711.
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