Form Uc-514 - Report Of Changes Page 2
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1
2REPORT OF CHANGES
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UC-514 (10-17)
P.O. Box 6028 • Mail Drop 5881 • Phoenix, AZ 85005-6028
ARIZONA ACCOUNT NUMBER
Telephone (602) 771-6602 • Fax (602) 532 5539
FEDERAL ID NUMBER
Report ANY CHANGES PROMPTLY (ownership, legal form, operation, payroll
method, or address of your business) as required by Arizona Administrative
Code R6-3-1703. Failure to do so could result in additional cost to you later.:
A.
Change in Mailing Address
NEW ADDRESS (No., Street, or P.O. Box)
MAIL NOTICE OF UNEMPLOYMENT CLAIMS TO (No., Street, or P.O. Box)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
PHONE NUMBER
PHONE NUMBER
B.
Change in the Business’ Email Address
Change in Sides E-Response Email Address
EMAIL
EMAIL
C.
Change in Arizona Ownership / Operation
All of the Arizona business was transferred to (complete item 1 below), as of
(date)
Part of the Arizona business was transferred to (complete items 1 and 2 below), as of
(date)
In the portion of business transferred, did you during the current or preceding calendar year: 1) Employ one or more
individuals for a part of a day in at least 20 weeks, or pay $1,500 or more in wages in a calendar quarter, OR 2) If the
business is agricultural, did you employ 10 or more individuals for a part of a day in at least 20 weeks, or pay $20,000
or more wages in a calendar quarter?
Yes
No
No ownership change occurred, but payroll is paid by (complete item 1 below), as of
(date)
No ownership change occurred, but leasing employees (complete item 1 below), as of
(date)
AZ Business was discontinued without being sold, leased or transferred, as of
(date)
Business is operating in Arizona, but ceased paying wages, as of
(date)
ITEM 1
NAME OF NEW OWNER, PARTNERSHIP, CORPORATION, PAYROLLER, LEASING COMPANY
PHONE NUMBER
ADDRESS (No., Street, P.O. Box, City, State, ZIP Code)
ARIZONA ACCOUNT NUMBER
ITEM 2
NAME OF BUSINESS YOU RETAINED
PHONE NUMBER
ADDRESS (No., Street, P.O. Box, City, State, ZIP Code)
D.
SIGNATURE AND TITLE OF OWNER, PARTNER, CORPORATE OFFICER OR AGENT
DATE
MAILING OR FORWARDING ADDRESS (No., Street, P.O. Box, City, State, ZIP Code)
PHONE NUMBER
FOR AGENCY USE ONLY
Change of owner
Inactive
Comments
Merge into
Suspend
Transfer to
Established in Error
Revise close code
Terminate
Close date
Initial
Date
See reverse for EOE/ADA/LEP/GINA disclosures
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