Form 37nc - Employer'S Notice Of Change
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1UI Form 37NC
STATE OF NEBRASKA
Employer Account Number
DEPARTMENT OF LABOR
UNEMPLOYMENT INSURANCE TAX
PO BOX 94600
LINCOLN, NE 68509-4600
Federal Id Number
Phone: 402.471.9898
Fax:
402.471.9994
Employer Name
EMPLOYER’S
NOTICE OF CHANGE
Return this form only if there are changes,
or submit account changes electronically at uiconnect.ne.gov
1. Change in Legal Name, Trade Name, Address and/or Federal Employer Identification Number.
Effective Date of change:
Mailing address changed to:
(Street, City, State, Zip Code)
Legal Name changed to:
Business Location changed to:
Trade Name Doing Business As changed to:
Phone Number changed to:
(Street, City, State, Zip Code)
Additional Nebraska locations added. Attach list
If Federal Employer Identification Number (FEIN) has changed for any reason, complete
providing full name and address of each location.
“Change of Ownership” section 3 below.
2. Request Account to be Placed on Inactive Status.
BANKRUPTCY INFORMATION-If Applicable
Closed business. Date last wages paid:
Reason closed:
Bankruptcy Petition #
State/District where filed
If sold, transferred or incorporated complete “Change of Ownership” section 3.
Operate without workers in Nebraska. Provide explanation:
Use Subcontractors. Provide names, trade names, addresses and phone
numbers of each. Attach list if necessary.
Corporate officer remunerations are wages and are reportable and taxable.
Other. Provide explanation:
New FEIN:
3. Change of Ownership – includes sale, merger, transfer, lease, incorporation.
Type of
Date of Acquisition
Entire Business Sold
Reorganization of existing business
Stock Ownership Change
(Provide list of officers)
change
Incorporation of existing business
Merger with existing business
Other _______________
Were services performed after the date of acquisition?
Yes
No If yes, explain
New Owner’s Legal Business or Individual Name
New Owner’s DBA or Trade Name, if different from Legal Name
New Owner’s Address
Contact Name
(Street, City, State, Zip Code)
Phone Number
Partial Sale Only – Explain what portion(s) of the business was acquired and the percentage of total business acquired.
What portion of the business do you still operate?
Will any of your workers be employed by the new owner listed above?
Yes
No If yes, how many?
I certify that the information provided in this report is true and correct to the best of my knowledge and belief.
Preparer’s Name (please print)
Title
Phone Number
Signature
Date
Revised 4-11
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