Form Ucs-3 - Employer Account Change
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1UCS-3
R. 10/00
Employer Account Change Form
Employer Name
U.C. Account No.
Check and complete only the items showing a change in your business. Sign, date and return
to: Florida Department of Revenue, 5050 W. Tennessee St, Tallahassee, FL 32399-0100.
Part I
Trade Name
Address
Telephone Number
Federal I.D. Number
Date Business Closed
Part II
A. Sold, leased or otherwise transferred all or part of the business to:.
Business Name
Date of Sale:
Owner's Name
Telephone No.
Address
Were all locations of the entire business operation and all its incidents (including equipment, assets, raw
materials) sold, leased or otherwise transferred to the new operator?
Yes
No
If No, list items retained:
B. Partnership formed or change. Explain (include effective date and list new and/or departing partners):
C. Corporation:
Formed
Dissolved
Inactivated
Corporate name change (Attach supporting documentation)
Change of Officers (Attach a list of Officers with SSN's home addresses, and telephone numbers
D. Partnership or individual operating without employees
E. Now using leased employees:
Name of leasing company
Date employees transferred
Date of Last Payroll
Location of terminated business records: Name
Address
Telephone No.
I understand that if it will be necessary for me to again report and pay taxes if at any time I resume operating, even
though in a different line of business and regardless of the extent of my employment.
Signature
Date
For Division Use Only
Part I
Part II
Completed by
Date
Completed By
Date
Internet Address:
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Parent category: Financial