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UA 1184-1

Authorized by

(Rev.12-98)

MCL 421.1, et seq.

State of Michigan

Department of Consumer & Industry Services

UNEMPLOYMENT AGENCY

Tax Office, Second Floor, Team _____

7310 Woodward Avenue

Detroit, Michigan 48202

UA Employer Number _____________________

Mail Date _______________________

Section 22 of the Michigan Employment Security Act reads in part:

“(a) If an employer subject to this Act transfers subsequent to June 30, 1954 any of the assets of his business by

any means otherwise than in the ordinary course of trade, such transfer shall be deemed a ‘transfer of business”

for the purpose of this section.

(b) Notwithstanding the provisions of subsection (a), a transfer of assets to a transferee which involves less than

75% of transferor’s assets shall not be deemed a transfer of business unless all of the following occur:

(1) The Agency is notified of the transfer of assets by the transferor or transferee within 30 days after the

end of the quarter in which the transfer occurred.

(2) The Agency receives within 30 days after the request therefor a written approval by the transferor and

transferee of a rating account transfer determined in accordance with provisions of subsection (d) (of this

section;)

(3) In the case of a transferee who elects under Section 25 to become subject as of the transfer date, the

Agency receives the election within 30 days after the mailing of a notice of his right to elect.”

Because the Agency has received timely notification indicating that you (the transferor) transferred less than 75% of your

assets to the individual, individuals or other legal entity (the transferee), the initial requirement to effect a partial rating

account transfer has been met [Section 22(b)(1)].

To comply with the provisions of Section 22(b)(2) and (b)(3), the Agency must have authorization from both you (the

transferor) and the transferee that a partial rating account transfer has been agreed upon. Your signatures in the spaces

provided below are certification to the Agency that:

(1) The transferee has used the assets acquired from you (the transferor) in the continuation of part of your

business operation;

(2) The payroll information requested on the reverse of this report is correct to the best of your knowledge

and should be used to determine the amount of money which will be deducted from your rating account and

credited to the transferee’s account;

(3) The transferee, if not a liable employer on the date of transfer, is electing to become a liable employer

under Section 25 of the Act, effective as of the date of transfer, for the purpose of obtaining a partial rating

account transfer; and lastly,

(4) That you (the transferor) and the transferee have agreed to this partial account transfer.

TRANSFEROR

TRANSFEREE

Signature: _____________________________________

Date: _________________________________________

Print Name: ____________________________________

Title: _________________________________________

(Owner, Partner, etc.)

Form Ua 1184-1 - Report And Agreement On Partial Transfer Of Business - Certification

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