Form Ucs-3 - Employer Account Change Form - Department Of Revenue printable pdf download

UCS-3

Employer Account Change Form

R. 01/05

I am requesting the following change(s) to my account.

(Complete only the items showing a change in your business.)

Current legal name

Unemployment Tax Account Number

–

Contact Information:

Mailing address __________________________________________________________________________________________

(Street address, City, State, ZIP)

Business location_________________________________________________________________________________________

Telephone number (________) ___________________________

Fax number (________) ____________________________

E-mail address________________________________________

Trade name (d/b/a) ________________________________

(Business, trade, or ﬁctitious [d/b/a] name)

Federal ID number, change to:

–

(attach supporting IRS documentation)

Corporation:

❏

Amendment to corporate charter

Ofﬁcer change only

Stock sale only

(attach Articles of Amendment)

❏

Corporate name change to: _____________________________________________________________________________

❏

Change in business activity? (Indicate new business activity) ___________________________________________________

Ceased Operations:

Date of last payroll in Florida:

–

❏

Change in business structure/legal entity status (eg: sole proprietor to corporation, corporation to LLC, etc.)

Date:_______________

New legal entity: ______________________________________________________________

❏

Sold business: (date) ___________________

All

Portion

To: (______) ___________________________________________________________________

(legal entity of new owner)

(address)

(telephone number)

*If you incorporated, changed your business structure/legal entity status, or purchased a business, you must complete an

Application to Collect and/or Report Tax in Florida (Form DR-1) and a Report to Determine Succession (Form UCS-1S).

Note: The Report to Determine Succession for partial acquisitions must be postmarked within 90 days of the

acquisition date to be considered timely.

❏

Leasing employees: Yes

Leasing company unemployment tax account number:

–

Leasing company federal employer identiﬁcation number:

–

❏

Date leasing relationship began _________________ Are all employees (including corporate ofﬁcers) leased? Yes

Sign and date:

__________________________________________________________________________

_______________________

Signature

Date

__________________________________________________________________________

(______) ________________

Title

Telephone number (include area code)

or fax to: 850-488-5833

Sign, date, and mail this Employer Account Change Form to:

FLORIDA DEPARTMENT OF REVENUE

For information and forms:

PO BOX 6510

TALLAHASSEE FL 32314-6510

800-482-8293

Form Ucs-3 - Employer Account Change Form - Department Of Revenue

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