Form De 24 - Change Of Employer Account Information
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2CHANGE OF EMPLOYER ACCOUNT INFORMATION
E.D.D. ACCOUNT NUMBER:
Mail to: Employment Development Department
Account Services Group MIC 28
Corporation
Owner’s Name:
P.O. Box 826880
Sacramento CA 94280-0001
Business
(DBA) Name:
Banking Institution:
PLEASE INDICATE CHANGES/CORRECTIONS THAT APPLY TO YOUR BUSINESS (A-1 BELOW):
A. Address Change/Correction: Date of Change:
(Enter address information in box 1)
/
/
1.
NUMBER AND STREET
CITY, STATE, AND ZIP CODE
TELEPHONE NUMBER
(
)
B. Business Name (DBA) Change:
Date of Change:
/
/
C. Corporation Name Change:
Date of Change:
/
/
D. Personal Name Change (i.e., marriage):
Date of Change:
/
/
E. Change of Ownership - Date of Change:
(Mark appropriate box below, and complete box 2 if
/
/
required):
Partial Sale, Not Out-Of-Business
Entire Business Sold (Enter successor(s) information in box 2)
Corporation Dissolved
Other (Explain):
Corporation Formed
Change in Ownership Type (Add information in box 2 and explain Type)
Purchase Price $
2.
OWNER’S NAME(S) FOLLOWING
BUSINESS NAME (DBA)/
MAILING
TITLE
CHANGE OF OWNERSHIP
CORPORATION NAME
ADDRESS
SOS Corporation,
New FEIN (Tax ID#):
OLD FEIN (Tax ID#):
LLC, LLP, or LP
Explain reason for new Tax ID:
Identification #:
F. Change in Partner(s), Officer(s), Member(s), Manager(s), etc. (Mark appropriate box to Add [A], Change [C], or
Delete [D], and enter the new information as required.) Attach additional sheet(s) if needed.
3.
DATE OF
INDIVIDUAL(S) TO BE ADDED/
SOCIAL SECURITY
DRIVER’S
TITLE
CHANGE
CHANGED/DELETED
NUMBER
LICENSE NUMBER
C
D
A
/
/
/
/
/
/
G. No wages paid during entire quarter(s). Please enter the appropriate year and quarter in the boxes provided.
(Example: YYYY/Q)
H. Discontinued Paying Wages. Date last wage payment was made:
. All required EDD TAX FORMS
/
/
have been filed. (Attach Copies)
I. If you currently use a Professional Employer Organization (PEO), please provide PEO information:
PEO Name:
PEO Address:
PEO EDD Account Number:
PEO Start Date:
DE 24 Rev. 5 (3-11) (INTERNET)
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