Form C-1am - Amended Status Report Page 2
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2Reopen Section
15. If you are filing this report to reactivate your inactive account, complete this section.
Mo.
Day
Yr.
The date you resumed employing individuals in Texas:
The date you resumed paying wages in Texas:
Suspend Section
16. If you are filing this report to inactivate your account, complete this section.
Mo.
Day
Yr.
The last day on which individuals performed services in Texas:
The date on which final wages were paid:
Employment in Texas was discontinued because:
(Check one):
Business discontinued entirely without a successor.
Business continued without employment.
Business, trade or organization was acquired by a successor.
If you sold a business in Texas you must complete Items 16 through 19.
Successor’s TWC Account Number (if known):
Successor’s Name:
Successor’s Address:
City, State, Zip:
Successor Acquired:
All the Texas business or assets.
(Check one):
Part of the Texas business or assets. Part Acquired (specify):
17. On the date of the acquisition, was the previous owner(s), or any partner(s), officer(s), shareholder(s) or other owner(s) of a legal or
equitable interest of the predecessor business, related by blood or marriage, to any of the owners, partners, officers or
Yes
No
shareholders of the successor business?
If “yes”, check all that apply:
Same owner, officer, partner, or shareholder
Same parent company
If other, describe:
Sole proprietor incorporating
Other
18. If “no”, on the date of the acquisition, did the previous owner(s), partner(s), officer(s), shareholders(s) or other owner(s) of a legal or
Yes
No
equitable interest hold an option to purchase such an interest in the successor business?
19. After the acquisition, did the predecessor continue to:
Yes
No
•
Own or manage the organization that conducts the organization, trade or business?
Yes
No
•
Own or manage the assets necessary to conduct the organization, trade or business?
•
Yes
No
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
No
If yes to any of above, describe:
Signature Section
20. 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 with a valid Written Authorization on file with the Texas Workforce
Commission.)
Mo.
Day
Yr.
Date Signed
Signature
Title
E-mail Address
Individuals may receive, review and correct information that TWC collects about the individual by emailing to open.records@twc.state.tx.us or writing to
th
TWC Open Records, 101 E. 15
St., Rm. 266, Austin, TX 78778-0001.
Page 2 of 2
C-1AM (042006)
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