Form Ucs 3 - Employer Account Change
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1UCS-3
Employer Account Change Form
R. 09/04
Unemployment Tax Account Number
Employer legal name ________________________________________________________
–
Complete only the items showing a change in your business.
Owner __________________________________________________________________________________________________
(Legal name of individual, principal partner, or corporation)
Business name (d/b/a) ________________________________
Telephone number (________) _________________________
(Business, trade, or fictitious [d/b/a] name)
Mailing address ___________________________________________________________________________________________
(Street address, City, State, ZIP)
Business location _________________________________________________________________________________________
Federal ID number
Fax number
–
–
–
Corporation:
Corporate name change (attach supporting documentation)
Will the same business activity continue under the new corporate name?
Yes
No
If No, please indicate new business activity ____________________________________________________________________________
Change of officers (attach list of officers with social security numbers, home addresses and telephone numbers)
Leasing employees:
Name of leasing company ______________________________________________________________
Unemployment Tax Account Number of leasing company
Date leasing began
Are all employees leased?
–
–
–
yes
no
Business closed:
Date of last payroll
Date business closed
–
–
–
–
If you incorporated 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.
__________________________________________________
_________________________________________________
Signature
Date
__________________________________________________
_________________________________________________
Title
Telephone number (include area code)
Sign, date, and mail this Employer Account Change Form to:
FLORIDA DEPARTMENT OF REVENUE
or
PO BOX 6510
fax to: 850-488-5833
TALLAHASSEE FL 32314-6510
For Information and Forms
Information and forms are available on our Internet site at
To speak with a Department of Revenue representative, call
Taxpayer Services, Monday through Friday, 8 a.m. to 7 p.m.,
ET, at 800-352-3671 or 850-488-6800.
To receive forms by mail:
For a written reply to your tax questions, write:
•
Order multiple copies of forms from our Internet site at
TAXPAYER SERVICES
/forms or
FLORIDA DEPARTMENT OF REVENUE
•
Fax your form request to the DOR Distribution Center at
1379 BLOUNTSTOWN HWY
850-922-2208 or
TALLAHASSEE FL 32304-2716
•
Call the DOR Distribution Center at 850-488-8422 or
Hearing or speech impaired persons may call the TDD line at
•
Mail your form request to:
800-367-8331 or 850-922-1115.
DISTRIBUTION CENTER
FLORIDA DEPARTMENT OF REVENUE
Department of Revenue service centers host educational
168A BLOUNTSTOWN HWY
seminars about Florida’s taxes. For a schedule of upcoming
TALLAHASSEE FL 32304-3702
seminars,
•
Visit us online at or
•
Call the service center nearest you.
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