Form Ui-50a - Notice Of Change
Download a blank fillable Form Ui-50a - Notice Of Change in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Ui-50a - Notice Of Change with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2UI-50A (Rev. 04/01)
IL 427-00016
STATE OF ILLINOIS
Stock No. 7193
DEPARTMENT OF EMPLOYMENT SECURITY
401 SOUTH STATE STREET
CHICAGO ILLINOIS 60605-1229
NOTICE OF CHANGE
Employer Name _____________________________________________
DBA Name _________________________________________________
ACCOUNT # ___________________________________________
Address ____________________________________________________
City, State, Zip ______________________________________________
INDICATE ANY CHANGES WHICH HAVE OCCURRED WITH RESPECT TO YOUR BUSINESS ENTERPRISE WITHIN THE STATE OF ILLINOIS
__________________________________________________________________________________________________
THE EMPLOYING UNIT NAMED ABOVE GIVES NOTICE OF CHANGE(S) WITH RESPECT TO ITS ILLINOIS BUSINESS EFFECTIVE ____________________
(DATE)
1. NAME CHANGE/ADDRESS CHANGE/MISCELLANEOUS CHANGES
__ Name changed without change in legal entity. New name _________________________________________________________________________________________
__ Doing Business As name changed without change in legal entity. New DBA name ____________________________________________________________________
__ Business address changed. New address _____________________________________________________________________________________________________
(Street)
_____________________________________________________________________________________________________________________________________________________
(City)
(State)
(ZIP)
__ Telephone number changed. New telephone number (______)____________________________________________________________________________________
__ Mailing address changed. New mailing address. Check if for:
__ BIS 32
__ UI-3/40
__ BEN-118/R
__ RATE NOTICE
__ BEN APPEALS
__ SI5
If you have multiple mailing addresses, complete form UI-1M, Unemployment Insurance Special Mailing Form.
If the Mailing Address is for an authorized representative, you must attach a Power of Attorney.
___________________________________________________________________________________________________________________(______)____________
(C/O)
(Street)
(City)
(State)
(ZIP)
(Telephone Number)
__ Change in basic product or service performed. (Identify new product or service performed) _____________________________________________________________
______________________________________________________________________________________________________________________________________
__ Other changes not indicated above. (Specify) __________________________________________________________________________________________________
2. REQUEST TO CLOSE ACCOUNT
Date you closed your business and/or ceased employing workers _____/_____/_____. If you entered a date here, you must also complete at least one of the items listed
below from A thouugh C. IF YOU REORGANIZED OR SOLD YOUR BUSINESS, YOU MUST ALSO COMPLETE THE REVERSE SIDE.
A. Date you discontinued operations in Illinois _____/_____/_____ Explain __________________________________________________________________________
B. Date you ceased employing workers, still operating in Illinois _____/_____/_____ Explain ___________________________________________________________
C. Date on which all wages ceased, regardless of whether this date is later than the date shown above _____/_____/_____
The name, business address and telephone number of the person in possession of all your payroll and employment records which pertain to periods prior to the
date above.
____________________________________________________________________________________________________________________________________________________________________
CERTIFICATION: I HEREBY CERTIFY THAT THE FOREGOING INFORMATION AND THAT CONTAINED IN ANY ATTACHED SHEETS SIGNED BY ME IS
TRUE AND CORRECT, AND THAT I AM AUTHORIZED TO EXECUTE THIS REPORT ON BEHALF OF THE EMPLOYING UNIT NAMED.
BUSINESS NAME _____________________________________________________________ DATE SIGNED AND SUBMITTED _____/_____/_____
SIGNED BY _______________________________________________________________________ OFFICIAL TITLE ________________________________________________
HOME ADDRESS OF OFFICIAL _______________________________________________________________________________________________________________
HOME TELEPHONE NUMBER (________)____________________________________
THIS REPORT MUST BE SIGNED BY OWNER, PARTNER, OFFICER OR AUTHORIZED AGENT WITHIN THE EMPLOYING ENTERPRISE. IF SIGNED BY ANY OTHER
PERSON, A POWER OF ATTORNEY MUST BE ATTACHED.
( SEE REVERSE SIDE FOR ADDITIONAL QUESTIONS)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ui-21 - Report Of Change In Ownership Or Discontinuance Of Business In Whole Or Part - Department Of Employment Services
Legal
Form Int-4 - Notice Of Change Of Ownership, Interest, Or Participation Of Interest In Project - Alabama Department Of Revenue
Financial
Related Categories
Parent category: Financial