Form Ui-1 - Report To Determine Succession - 2003

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UI-1 S&P (Rev. 06/03)
STATE OF ILLINOIS
DEPARTMENT OF EMPLOYMENT SECURITY
33 SOUTH STATE STREET
CHICAGO, ILLINOIS 60603-2802
REPORT TO DETERMINE SUCCESSION
1.
a.
Date of acquisition (or change of business entity, for example, from a sole proprietor to a corporation) ______________________
b.
Is the previous owner still doing business? _______ YES ________ NO
c.
If NO, indicate the date the previous operation ceased doing business ________________________________________________
d.
If there is a gap of seven days or more between 1. a. and 1. c., please explain __________________________________________
2.
a.
Name of previous owner ____________________________________________________________________________________
Doing business as _________________________________________________________________________________________
Illinois U.I. account number (if known) ______________________ Fed. ID. Number (if known) ________________________________
Address: _________________________________________________________________________________________________
________________________________________________________________________________________________________
2.
b.
Name of current owner _____________________________________________________________________________________
Doing business as _________________________________________________________________________________________
What is your primary business activity in Illinois? ________________________________________________________________
What is your principal product or service?_________________ % Sales or Receipts ____________________________________
Illinois U.I. account number ____________________________ Fed. ID. Number ______________________________________
Address: _________________________________________________________________________________________________
________________________________________________________________________________________________________
Check all boxes that apply to you:
3.
What is the nature of this acquisition or change of business entity?
A.
________ Purchase of Business ________ Entirely ________ In Part (Explain) ________________________________
B.
________ Lease of Business ________ Entirely ________ In Part (Explain) __________________________________
C.
________ Change in Type of Business Entity:
From: ____ Sole Proprietor ____ Partnership ____ Corporation ____ Other (Explain) __________
To:
____ Sole Proprietor ____ Partnership ____ Corporation ____ Other (Explain) __________
D.
________ Admission/withdrawal of 50% or more of the partners.
If checked, explain __________________________________________________________________________________
E.
Corporate Change:
______ Merger or consolidation ______ Reorganization ______ Issuance of new corporate charter
F.
______ Foreclosure ________ Receivership ________ Bankruptcy
If bankruptcy was checked, did you purchase the assets through federal bankruptcy court? _______ YES _______ NO
G.
Death of ________ Owner ________ Partner
4.
a.
Did the former owner operate at more than one location in Illinois? _______ YES _______ NO

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