Form De 24 - Change Of Employer Account Information Page 2
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2J. Out of Business (Without a Successor) on:
. (Provide forwarding address in box A1)
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Note: If business corporation/owner is represented by an authorized agent for employment tax purposes, the
agent may sign below. A signed and properly executed power of attorney must be attached or on file. THE
SIGNATURE OF ANY OTHER PERSON/THIRD PARTY WILL NOT BE ACCEPTED.
“I certify under penalty of perjury that the above information is true and correct, and that these actions are not being
taken to receive a more favorable Unemployment Insurance Rate. I further certify that I have the authority to sign on
behalf of the above business.”
(
)
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Signature
Telephone Number
Date
Print Name
Title (Officer, Owner, Member, GP, or Authorized Agent)
DE 24 Rev. 5 (3-11) (INTERNET)
Page 2 of 2
CU
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Parent category: Legal