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


UA 1184-1
Authorized by
MCL 421.1, et seq.
State of Michigan
Department of Consumer & Industry Services
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
(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.
Signature: _____________________________________
Signature: _____________________________________
Date: _________________________________________
Date: _________________________________________
Print Name: ____________________________________
Print Name: ____________________________________
Title: _________________________________________
Title: _________________________________________
(Owner, Partner, etc.)
(Owner, Partner, etc.)


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