NEBRASKA WORKFORCE DEVELOPMENT
OFFICIAL USE ONLY
DEPART OF LABOR
Predecessor Liable Number
PO Box 94600
File Locator Number
Lincoln NE 68509-4600
Successor Liable Number
EMPLOYER’S REPORT ON CHANGE OF OWNERSHIP
(To Be Filed by the Predecessor)
1. Did a successor employer acquire your business?
Date successor acquired business :
Name and Address of Successor:
2. Did the successor employer acquire ALL or PART of your business?
(Acquisition of one of several locations in Nebraska is considered PART of the business)
3. How acquired?
4. Did the successor acquire the organization or assets of your business?
5. Is the successor serving the same customers and/or offering the same service or product?
6. If the successor acquired only PART of your business, list any place of business owned by you IN NEBRASKA which were not included in the change
7. Will you start or acquire another business after the date of sale?
8.Indicate name, address and telephone number to be used for future correspondence, if necessary.
If you have any questions or need assistance completing this form, contact our Status Unit at (402) 471-9935 or our Fax number is (402) 471-9994.
UI Form 37 (Revised 9-03)