Form C-38 - Transfer Of Compensation Experience Questionnaire

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Mail To:

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Cashier - Texas Workforce Commission

P.O. Box 149037

Austin, TX 78714-9037

512.463.2731

TRANSFER OF COMPENSATION EXPERIENCE QUESTIONNAIRE

PREDECESSOR IDENTIFICATION

SUCCESSOR IDENTIFICATION

Employer Name

Address

City, State, ZIP

Account No.

Date of Acquisition

Chapter 204, Subchapter E of the Texas Unemployment Compensation Act requires the transfer of compensation experience from a predecessor employer to a

successor employer, under certain circumstances. To determine whether this provision is applicable to you, this questionnaire must be completed and returned to

TWC. . If a partial acquisition occurred, the predecessor/successor may jointly submit information regarding a partial transfer of experience.

On the date of the acquisition, was the previous owner(s), or any partner(s), officer(s), shareholder(s), other owner(s) or a person related by blood or marriage to

any of these individuals, holding a legal or equitable interest in the predecessor business, also an owner, partner, officer, shareholder, or other owner of a legal or

equitable interest in the successor business?

Yes

If “Yes”, please indicate below the predecessor’s relationship to the successor.

Myself

Spouse*

Mother

Father

Son

Daughter

Son-in–law*

Daughter-in-law*

Mother-in-law*

Father-in-law*

Other (Specify)

*Termination of a marriage by divorce or the death of a spouse terminates relationships by affinity created by that marriage unless a

child of that marriage is living, in which case the marriage is treated as continuing to exist as long as a child of that marriage lives.

If “No”, on the date of the acquisition, did the previous owner(s), partner(s), officer(s), shareholder(s), other owner(s) or a person related by blood or marriage to

any of these individuals, holding a legal or equitable interest in the predecessor business, hold an option to purchase such an interest in the successor

business?

Yes

After the acquisition, did the predecessor continue to do any of the following:

•

Own or manage the organization that conducts the organization, trade, or business?

•

Own or manage the assets necessary to conduct the organization, trade, or business?

•

Control through security or lease arrangement the assets necessary to conduct the organization, trade, or business?

•

Direct the internal affairs or conduct of the organization, trade or business?

Yes

If yes, describe:

I hereby certify that the preceding information is true and correct, and that I am authorized to execute this Transfer of Compensation Experience Questionnaire on behalf of

the Employing Unit named herein. (This report must be signed by the owner, officer, partner OR individual with a valid Written Authorization on file with the Texas

Workforce Commission.)

Date of signature:

Month

___ Day

___ Year

___

Sign here ___________________________________

Title

_______________

Driver's license number

___________

State