Form Uitl-2 - Employer Change Request
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1Colorado Department of Labor and Employment
303-318-9100 (Denver-metro area) or
Unemployment Insurance Employer Services
1-800-480-8299 (outside Denver-metro area)
P.O. Box 8789, Denver, CO 80201-8789
EMPLOYER CHANGE REQUEST
Please type or use black ink and return to the above address. Instructions are on page 2. If you have any questions, call one of the above
telephone numbers.
PART I—EMPLOYER INFORMATION. All information in Part I must be completed by the person making the change request.
Owner, Partners, or Corporate Name
Employer Account Number
Trade Name
Street Address
City
State
ZIP Code
The form must be signed in Part IV; if this form is not signed, it cannot be processed.
PART II—CHANGE OF OWNERSHIP/TERMINATION OF BUSINESS OR EMPLOYMENT
Sole proprietorship or partnership incorporating are considered as new businesses. Change of ownership includes changing 50
percent or more in a partnership.
NOTE: Do not complete this form if you are only transferring corporate stock.
1. Date of termination or change: _______/______/______.
b. Date employer in Part I last paid wages:____/____/_____.
2. Did the employer in Part I have seasonal status with the Division?
Yes
No
3. Reason for change or termination:
a. Business closed
e. Partial sale of business (Contact the
g. Incorporation
b. No paid employees
Department for information concerning
h. Merger
(Include corporate officers)
partial transfer of experience rate to the
i. Other _____________
buyer)
__________________
c. Consider workers to be contract
f. All employees being reported by
labor
employee leasing company or
d. Sale of entire business (All
management company
locations)
Name:
Account Number:
4. a. Will the employer in Part I continue to have employees in Colorado?
Yes
No
b. If boxes d, e, f, g, h, or i are checked above, the new employer listed below must complete Form UITL-100, Application for
Unemployment Insurance Account and Determination of Employer Liability.
1.
Name of new employer ________________________________________________________________________________
2.
Trade name of new employer ___________________________________________________________________________
3.
Address of new employer ______________________________________________________________________________
c. If partial sale, were any employees transferred from the employer in Part I to the new employer listed above?
Yes
No
If Yes, 1. How many employees were transferred? ___________________________
2. List the total number of employees in your entire business in each of your four pay periods preceding the date of sale.
This includes all employees in the portion sold and all employees in the portion retained.
______________________
____________________
_____________________
____________________
—
PART III
CHANGE OF NAME OR ADDRESS ONLY (Must also complete Part I with previous address)
If this is a change of address, this change is for:
Physical location address
Mailing address for ALL premium information
Mailing address for all benefits information
Trade name change
New Partner(s), Corporate Name (If a corporate name change, include a copy of the Certificate of Amendment)
New Trade Name
New In Care of Name (if applicable)
Telephone Number
New Street
City
State
ZIP Code
PART IV—CERTIFICATION OF CHANGE
I certify that I am authorized to make this report and the information is correct.
Signature
Date
Title
Telephone Number
UITL-2 (R 08/2010)
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