Form C-1am - Amended Status Report - Texas Workforce Commission
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1
2Mail To:
Amended Status Report
Texas Workforce Commission
This report should be used to update your account with TWC
P.O. Box 149080
Please complete items 1 through 8, any other item that needs to be updated,
Austin, Texas 78714-9080
and sign the report in item 14 on the back.
(You should retain a copy for your files)
TWC Use Only
County Code
Tax Area
Identification Section
1. Account number assigned by TWC
5. Federal Employer I.D. Number
2. Name
6. Area Code/Phone Number
3. Mailing address
7. Address of Records/Payroll
4. City, State, Zip
8. City, State, Zip
9. Owners’ or Officers’ Name
Soc. Sec. No.
Title
Residence Address, City, State
10. Business location(s) in Texas
Tradename
Street Address, City
Kind of Business
No. Employees
Acquisition Section
11. If you acquired the business in Texas of a previous owner, complete this section.
Mo.
Day
Yr.
Date of acquisition:
Previous Owner’s TWC Account Number (if known):
Previous Owner’s Name:
Previous Owner’s Address:
City, State, Zip:
Portion of business acquired:
(Check one):
All
Part (Specify)
Continued on Reverse Side
C-1AM(0799) Inv. No. 518100
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