Form Uct-115-E - Report Of Business Transfer (Sale, Acquisition, Or Reorganization) - Wisconsin Department Of Workforce Development - 2016 Page 2

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6. Method of Transfer
Sale
Foreclosure
Sale of corporate stock
Management contract
Cancellation of lease
Merger or consolidation
Inheritance
Lease
Reorganization (change
Other:
Bankruptcy sale
Receivership
of legal form)
7. Assets Transferred
Real Estate
Machinery and equipment
Franchises & licenses
None
Inventories
Furniture and fixtures
Goodwill
Other (explain):
Contracts
Accounts Receivable
Customer lists
8. Continuation of Business
Has the new owner/operator continued to operate the same business activity without interruption?
Yes
No
Has the new owner/operator continued to operate the same business activity in the same location? (If No, give
Yes
No
address of new location below).
If you answered "No" to either question above, explain fully
New Street Address
City
State
Zip Code
9. Number of Employees
How many employees worked in the
How many employees continued with the new
transferred business just prior to transfer?
owner/operator?
10. Identify Nature of Business Transferred
What specific business activity was transferred?
11. Total or Partial Transfer
Total transfer of former owner/operator's Wisconsin business operations
What is the former owner/operator's last date of payroll?
___/___/______
Provide explanation if last date of payroll is after the transfer effective date
Partial transfer of former owner/operator's Wisconsin business operations
Type of business kept by former owner/operator
Trade Name
Number of employees kept
Business location street address
City
State
Zip Code
Estimate the percentage of former owner/operator's defined (taxable) payroll incurred in the transferred
%
portion during the 12 months immediately preceding the transfer
12. Signature of Authorized Representative Required:
This report is submitted on behalf of:
Former Owner Authorized Representative Name and Position
Signature
Date
Phone Number
(
)
Phone Number
New Owner Authorized Representative Name and Position
Signature
Date
(
)
Both: Signatures of authorized representatives of both the former and new owners are required above
Contact Person Name and Position
Contact Phone Number/Email address
(
)
Print Form
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