Form C-1am - Amended Status Report - Texas Workforce Commission Page 2
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2Reopen Section
12. If you are filing this report to reactivate your inactive account, complete this section.
Mo.
Day
Yr.
The date you resumed employing someone in Texas:
The date you resumed paying wages in Texas:
Suspend Section
13. If you are filing this report to inactivate your account, complete this section.
Mo.
Day
Yr.
The last day on which anyone performed services in Texas:
The date on which final wages were paid:
Employment in Texas was discontinued because:
(Check one):
1. Business discontinued entirely without a successor.
2. Business continued without employment.
3. Business, trade or organization was acquired by a successor.
If you checked box 3, enter the following about the successor:
Successor’s TWC Account Number (if known):
Successor’s Name:
Successor’s Address:
City, State, Zip:
Successor Acquired:
1. All the Texas business or assets
(Check one):
2. Part of the Texas business or assets.
Part Acquired:
Signature Section
14. I hereby certify that the preceding information is true and correct, and that I am authorized to execute this Amended Status Report
on behalf of the Employing Unit named herein. (This report must be signed by the owner, officer, partner or individual for whom a
valid Written Authorization is on file with the Texas Workforce Commission.)
Mo.
Day
Yr.
Signature
Title
Completed forms, inquiries, or corrections to the individual information contained in this form shall be sent to the TWC Tax and
Labor Law Department, 101 E 15th St, Room 504, Austin, TX 78778-0001, (512) 463-2699. An individual may receive and review
information that TWC collects regarding that individual by sending an e-mail to open.records@twc.state.tx.us or writing to TWC
Open Records Section, 101 East 15th Street, Room 266, Austin, TX 78778-0001.
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