Form Jfs 66302 - Report To Determine Liability Transfer Of Business
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2Ohio Department of Job and Family Services
REPORT TO DETERMINE LIABILITY
TRANSFER OF BUSINESS
Attention: Contribution Section
P.O. Box 182404
Columbus, Ohio 43218-2404
(614) 466-2319 extension 22485
1.a. Former Owner’s Name
1.b. Former Owner’s ODJFS Account # (if known)
1.c. Former Owner’s Current Address (if known)
1.d. Former Owner’s Telephone # (if known)
1.e. Physical address of business acquired (street)
(city)
(state)
(zip)
2. How did you acquire the business?
Purchase
Lease
Incorporation
Partner Addition
Formed LLC
Foreclosure
Merger
Partner Withdrawal
Court order
(name of court)
(case #)
(title)
Leasing Employees
(name of leasing company)
(effective date)
Other (explain)
3. Attach a copy of the agreement or contract related to the acquisition of the business.
4.a. On what date did you acquire the trade or business?
4.b. Was the trade or business being operated in Ohio at the time
of acquisition?
Yes
No
4.c. If no, when did the former owner cease operation
5.a. Did you acquire all of the former owner’s trade or business
locations in Ohio?
Yes
No
5.b. If no, list the trade or business locations the former owner still operates in Ohio (If not sufficient space, attach supplemental sheet):
(trade name)
(street)
(city)
(state)
(zip)
6.a. Did you acquire all of the former owner’s trade or business in Ohio?
6.b. If no, list the parts of the former owner’s trade or business in Ohio
you did not acquire?
Yes
No
7. Person in charge of payroll records and address where payroll records are kept.
(trade name)
(street)
(city)
(state)
(zip)
(telephone #)
CERTIFICATION: I hereby certify that the information given in this report is true to the best of my knowledge and belief.
(acquiring employer’s name)
(ODJFS account #, if any)
(telephone #)
(employer signature)
(title)
(date)
(street)
(city)
(state)
(zip)
INFORMATION FURNISHED ON THIS REPORT WILL BE USED TO DETERMINE LIABILITY FOR CONTRIBUTIONS UNDER THE OHIO
UNEMPLOYMENT COMPENSATION LAW.
Prepared by (name)
(telephone #)
(date)
PLEASE SEE REVERSE SIDE FOR LAW AND RULES APPLICABLE TO THE TOTAL AND PARTIAL
TRANSFER OF EMPLOYMENT EXPERIENCE.
JFS 66302 (4/2010)
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