Form De 24 - Change Of Employer Account Information
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1CHANGE OF EMPLOYER ACCOUNT INFORMATION
ENTER ACCOUNT NUMBER:
Mail to: Employment Development Department
Account Services Group MIC 28
Owner’s Name:
PO Box 826880
Sacramento CA 94280-0001
Business Name:
PLEASE INDICATE THE CHANGE(S) / CORRECTION(S) TO YOUR BUSINESS BELOW:
A. Address Change / Correction:
Date of Change:
/
/
1
NUMBER AND STREET
CITY, STATE, AND ZIP CODE
PHONE NUMBER
(
)
B.
Business Name (DBA) Change:
Date Of Change:
/
/
C.
Corporation Name Change:
Date Of Change:
/
/
D.
Personal Name Change (i.e.; marriage):
Date Of Change:
/
/
E.
Discontinued Paying Wages. Date last wage payment was made:
/
/
F.
Out Of Business (Without A Successor). Out Of Business Date:
/
/
(Provide forwarding address in box 1)
G.
Change Of ownership – Date Of Change:
/
/
(Mark Appropriate Box Below):
Partial Sale, Not Out-Of-Business
Entire Business Sold (Enter successor(s) information in box 2)
Corporation Formed
Partnership To Sole (Enter sole proprietor’s information in box 2)
Corporation Dissolved
Other (Explain):
2
OWNER’S NAME
(S)
FOLLOWING
BUSINESS NAME / CORPORATION
MAILING
TITLE
CHANGE OF OWNERSHIP
(DBA)
NAME
ADDRESS
New Federal Employer Identification Number:
Secretary Of State Corp / LLC / LLP / LP Identification Number:
H.
Added /
Withdrew Partner(s), Officer(s), Member(s), Manager(s), etc.
(Enter information on individual(s), added or withdrawn below)
3
INDIVIDUAL(S)
TITLE
SOCIAL SECURITY NUMBER
DRIVER’S LICENSE NUMBER
ADDED/WITHDRAWN
REMINDER:
If you have discontinued paying wages or have gone out of business, you have 10 days to file your final DE 88
coupon with payment, Quarterly Wage and Withholding Report (DE 6), and Annual Reconciliation Statement (DE 7).
/
Print Name
Signature
Date
(
)
Phone Number
Title
DE 24 Rev. 3 (10-04) (INTERNET)
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CU
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