Form Ui-50a - Notice Of Change - 1998

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UI-50A (Rev. 1/98)

STATE OF ILLINOIS

IL 427-00016

DEPARTMENT OF EMPLOYMENT SECURITY

Stock No. 7193

401 SOUTH STATE STREET

CHICAGO, ILLINOIS 60605-2280

NOTICE OF CHANGE

ACCOUNT #___________________________________

INDICATE EACH CHANGE WHICH HAS OCCURRED WITH RESPECT TO YOUR BUSINESS ENTERPRISE WITHIN

THE STATE OF ILLINOIS. COMPLETE ALL OTHER ITEMS ON FORM AS REQUIRED. SIGNATURE REQUIRED ON

REVERSE SIDE.

............................................................................................................................................................................................................................................

THE EMPLOYING UNIT NAMED ABOVE HEREBY GIVES NOTICE OF CHANGE(S) WITH RESPECT TO ITS ILLINOIS

BUSINESS EFFECTIVE THE CLOSE OF BUSINESS ON __________________ .

DATE

1. INFORMATIONAL CHANGES

____ Name changed without change in legal entity. New name __________________________________________

____ Business Address changed. New Address ______________________________________________________

____ Telephone Number __________________________________________________________________________

____ Mailing Address changed. New Mailing Address __________________________________________________

____ Change in basic product, or service performed ___________________________________________________

____ Other changes not indicated above (Specify) ____________________________________________________

2. ORGANIZATIONAL CHANGES

____ Discontinued operations in Illinois (Explain in detail) _______________________________________________

____ Ceased employing workers, still operating in Illinois (Explain in detail) ________________________________

Date on which all wages ceased, regardless of whether this date is later than the date

shown above ____________________ .

The name, business address and telephone number of the person in possession of all your payroll and

employment records which pertain to periods prior to the date above. ________________________________

__________________________________________________________________________________________

3. OTHER ORGANIZATIONAL CHANGES

____ Sale of enterprise: ______ Entirely; ______ In part (If yes, complete numbers 6 and 7 on back)

____ Lease of enterprise: ______ Entirely; ______ In part (if yes, complete numbers 6 and 7 on back)

____ Change in type of business structure:

From: _____ Sole Proprietorship: _____ Partnership: _____

Corporation FEIN

_________________

To:

_____ Sole Proprietorship: _____ Partnership: _____

Corporation FEIN

_________________

____ Partnership reorganization (Explain in detail)

____ Corporate merger or consolidation (Explain in detail) ______________________________________________

____ Corporate reorganization (Specify)_____________________________________________________________

____ Sale of assets without dissolution — Corporate Charter retained (if yes, complete numbers 6 and 7 on back)

____ Dissolution (Give details regarding disposition of assets) ___________________________________________

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