Form Uc 1772 - Discontinuance Or Disposition Of Business Or Assets - 2002
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2UC 1772
State of Michigan
Authorized by
(Rev. 11-02)
Department of Consumer & Industry Services
MCL 421.1, et seq.
BUREAU OF WORKERS’ & UNEMPLOYMENT COMPENSATION
Tax Office
P.O Box 8068 – Royal Oak, Michigan 48068-8068
Discontinuance or Disposition of Business or Assets
NOTICE:
Information furnished on this report is used to determine termination of liability under Section 24 of the Michigan Employment
Security Act (MCL 421.24). This report is required even though you may not be employing any workers at present. Failure
to provide this information may result in a determination being made on the basis of the best information available.
1. Name and address used prior to Discontinuance or Disposition of Business.
a. Name ______________________________________________
UC Account No. _________________________________
b. Business Address ______________________________________________________________________________________
c. Telephone (______) ___________________________
Federal Employer ID (FEIN) _______________________________
2. Current name and address used since Discontinuance or Disposition of Business.
a. Name ______________________________________________
b. Business Address ______________________________________________________________________________________
c. Telephone (______) ___________________________
3. Name and address of person having custody of books and records.
a. Name ______________________________________________
b. Business Address ______________________________________________________________________________________
c. Telephone (______) ___________________________
4. Type of Organization (check one)
Individual
Partnership
Corporation
Limited Liability Partnership
Limited Liability Company
Other (explain) ___________________________________________________________
a. Give the following information concerning owner(s), partners, corporate officers, etc.
HOME
SOCIAL SECURITY
NAME
ADDRESS
TELEPHONE
NUMBER
_________________________
___________________________
__________________
______________________
_________________________
___________________________
__________________
______________________
_________________________
___________________________
__________________
______________________
_________________________
___________________________
__________________
______________________
5. Reason(s) for Discontinuance or Disposition in Whole or in Part (check one or more).
Sale
Reorganization
New Partnership
Lease
Bankruptcy
Incorporation
Foreclosure
Dissolution/Discontinued
Death
Merger
No Employees
Employee Leasing (attach copy of agreement)
Other-explain) ________________________________________________________________________________________
_______________________________________________________________________________________________________
a. Date of Disposition ______________________________
b. Date of Last Payroll __________________________________
c. Was business discontinued prior to disposition?
Yes
No If Yes, when? __________________________________
6. Number of places of business in Michigan ___________ Number of Michigan places disposed of _____________
a. Did you discontinue all employment in Michigan?
Yes
No If not, how many employees were retained? _________
b. Have you continued or resumed business in Michigan?
Yes
No If Yes, complete below:
__________________________________________
__________________________________________________________
LEGAL NAME OF BUSINESS
ADDRESS
__________________________________________
__________________________________________________________
NATURE OF BUSINESS
DATE(S) RESUMED BUSINESS
If you need assistance, telephone 1-800-638-3994, outside Michigan 1-313-456-2180.
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