Form Jfs 66302 - Report To Determine Liability Transfer Of Business Page 2
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1
2Ohio Department of Job and Family Services
REPORT TO DETERMINE LIABILITY
TRANSFER OF BUSINESS BETWEEN COMMON OWNERS
Attention: Contribution Section
P.O. Box 182404
Columbus, Ohio 43218-2404
(614) 466-2319 extension 22485
The Ohio Unemployment Compensation Law requires that if part of a trade or business transfers between employers who
are under “substantially common ownership, management, or control,” then the unemployment experience attributable to
the transferred portion must be transferred to the acquiring employer(s). The transferred experience will be used in
determining the acquiring employer’s subsequent contribution rates.
1. Did you acquire a portion (less than 100%) of a trade or business from an employer with which your business has common
ownership, management, or control?
Yes
No
If yes, you must complete items 2 through 7.
2.
Transferor’s Name
Transferor’s Current Address
Transferor’s ODJFS Account Number
Transferor’s Telephone Number
Acquiring Employer’s Name
Acquiring Employer’s Current Address
Acquiring Employer’s ODJFS Account Number
Acquiring Employer’s Telephone Number
3.
Provide the address, location, and a description of the transferred portion as it existed before the transfer
4. Provide the date of the transfer
5. Provide the date of first employment subject to the Ohio Unemployment Compensation Law for the transferred portion before it
was transferred
6. Provide the gross and taxable payroll totals attributable to the transferred portion for the four calendar quarters immediately
preceding the quarter in which the transfer occurred:
Quarter/Year
Gross Wages
Taxable Wages
7. Provide on a separate sheet the names and social security numbers of the employees transferred. If more than 20 employees
transferred, please provide this information via CD or other electronic media.
I hereby certify that the information given above is true and correct to the best of my knowledge and belief:
Signature
Title
Date
Please See Reverse Side for More Information
JFS 66302 (4/2010)
Page 3 of 4
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