Form Uia 1184 - Employer'S Report On Partial Transfer Of Business

Form Uia 1184 - Employer'S Report On Partial Transfer Of Business - 2015

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TATE OF

ICHIGAN

RICK SNYDER

TALENT INVESTMENT AGENCY

STEPHANIE COMAI

GOVERNOR

DIRECTOR

UNEMPLOYMENT INSURANCE AGENCY

-M

, UIA

HARON

OFFETT

ASSEY

DIRECTOR

Employer’s Report on Partial Transfer of Business

UIA Employer Account Number:

Mail Date:

On or about

you transferred a portion of your business to:

from the information available, it appears that as a result of this transfer, the Transferee

qualified for a pro rata assignment of your Experience Rating Account.

The percent of transfer is determined on the basis of wages of employees whose services

were performed in connection with the transferred portion of your business during the four (4)

completed calendar quarters preceding the transfer date.

In order to accurately transfer a portion of your Experience Rating Account and properly

allocate any unemployment benefits which might have been charged erroneously to your

account, please complete the back of this form and return it within 30 calendar days from the

mail date shown above. Failure to comply within 30 days will necessitate a rating account

determination on the basis of the best information available. This may also result in a No-

Transfer.

I certify that the information contained in this report is true and correct to the best of my

knowledge.

___________________________________

____________________________

Signature

Date

___________________________________

_____________________________

Print Name

Title

UIA 1184

(Rev. 03-15)

TIA is an equal opportunity employer/program.

Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

CADILLAC PLACE • 3024 W. GRAND BLVD. • DETROIT, MICHIGAN 48202 •

Form Uia 1184 - Employer'S Report On Partial Transfer Of Business - 2015

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